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Full text of "normal findings on CT and MRI"

THIEME FLEXIBOOK 



Normal Findings 
in CT and MRI 




Normal Findings in CT and MRI 



Torsten B. Moeller, M.D. Emil Reif, M.D. 

Am Caritas-Krankenhaus Am Caritas-Krankenhaus 

Dillingen/Saar Dillingen/Saar 

Germany Germany 

210 Illustrations 




Thieme 

Stuttgart ■ New York 2000 



Moeller, Normal Findings in CT and MRI © 2000 Thieme 

All rights reserved. Usage subject to terms and conditions of license. 



Library of Congress Cataloging-in-Publication Data 

Moeller, Torsten B. 

[CT- und MRT-Normalbefunde. English] 

Normal findings in CT and MRI / Torsten B. Moller, Emil Reif. p. cm. 

Includes bibliographical references and index. 

ISBN 0-86577-864-7 (TNY). - ISBN 3-13-116521-9 (GTV) 

1. Tomography. 2. Magnetic resonance imaging. 3. Reference values (Medicine) 

4. Human anatomy. I. Reif, Emil. II. Title. 

[DNLM: 1. Magnetic Resonance Imaging. 2. Tomography, X-Ray 
Computed. WN 185 M726c 1999a] 
RC78.7.T6M6413 1999 
616.07'57-dc21 

DNLM/DLC 99-33663 

for Library of Congress CIP 



This book is an authorized and revised 
translation of the 1st German edition 
published and copyrighted 1998 by 
Georg Thieme Verlag, Stuttgart, Ger- 
many. Title of the German edition: CT- 
und MRT-Normalbefunde 

Some of the product names, patents, 
and registered designs referred to in this 
book are in fact registered trademarks 
or proprietary names, even though 
specific reference to this fact is not al- 
ways made in the text. Therefore, the 
appearance of a name without designa- 
tion as proprietary is not to be con- 
strued as a representation by the pub- 
lisher that it is in the public domain. 
This book, including all parts thereof, is 
legally protected by copyright. Any use, 
exploitation, or commercialization out- 
side the narrow limits set by copyright 
legislation, without the publisher's con- 
sent, is illegal and liable to prosecution. 
This applies in particular to photostat 
reproduction, copying, mimeographing 
or duplication of any kind, translating, 
preparation of microfilms, and elec- 
tronic data processing and storage. 

© 2000 Georg Thieme Verlag, 
Riidigerstrasse 14, 
D-70469 Stuttgart, Germany 
Thieme New York, 333 Seventh Avenue, 
New York, NY 10001, USA 

Typesetting by primustype R. Hurler 
GmbH, D-73274 Notzingen, Germany 
typeset on Textline/HerculesPro 
Cover design by Cyclus, Stuttgart 
Printed in Germany by 
Offizin Andersen Nexo, Leipzig 

ISBN 3-13-116521-9 (GTV) 
ISBN 0-86577-864-7 (TNY) 

12 3 4 5 6 



Important Note: Medicine is an 
ever-changing science undergoing 
continual development. Research 
and clinical experience are continu- 
ally expanding our knowledge, in 
particular our knowledge of proper 
treatment and drug therapy. Insofar 
as this book mentions any dosage or 
application, readers may rest as- 
sured that the authors, editors, and 
publishers have made every effort to 
ensure that such references are in 
accordance with the state of 
knowledge at the time of produc- 
tion of the book. 

Nevertheless, this does not involve, 
imply, or express any guarantee or 
responsibility on the part of the 
publishers in respect to any dosage 
instructions and forms of applica- 
tion stated in the book. Every user 
is requested to examine carefully 
the manufacturer's leaflets accom- 
panying each drug and to check, if 
necessary in consultation with a 
physician or specialist, whether the 
dosage schedules mentioned therein 
or the contraindications stated by 
the manufacturers differ from the 
statements made in the present 
book. Such examination is particu- 
larly important with drugs that are 
either rarely used or have been 
newly released on the market. Every 
dosage schedule or every form of 
application used is entirely at the 
user's own risk and responsibility. 
The authors and publishers request 
every user to report to the publish- 
ers any discrepancies or inaccura- 
cies noticed. 



Moeller, Normal Findings in CT and MRI © 2000 Thieme 

All rights reserved. Usage subject to terms and conditions of license. 



To my father, Alfred Moeller, 
in love and gratitude 



Moeller, Normal Findings in CT and MRI © 2000 Thieme 

All rights reserved. Usage subject to terms and conditions of license. 



Preface 



This book, like its conventional counterpart Normal Findings in Ra- 
diography, deals with the apparently banal subject of the normal. It 
addresses the question of how to recognize what is normal and how to 
describe normal findings. These questions are as important in com- 
puted tomography and magnetic resonance imaging as in other modali- 
ties. Even "sectional imaging" is based on the classical approach of read- 
ing images and formulating findings. 

This book follows the same format used in Normal Findings in Radiogra- 
phy. Each section starts with a brief descriptive interpretation of normal 
findings in the region of interest. Next comes a checklist that follows the 
sequence of the descriptive text and provides a systematic framework 
for image interpretation. Some of the checklist entries offer phrasing 
suggestions that may be helpful in the formulation of findings. Most 
sections conclude with a table of "Important Data" listing the normal 
ranges of values for the most important measurable parameters. 
Of course, the "normal findings" presented here can only assist the radi- 
ologist in formulating his or her own findings. But regardless of 
whether we are taking a brief look or conducting a detailed evaluation, 
the system that is used in radiological interpretation should be reflected 
in the clarity and precision of the findings. This book is intended to 
further that goal. 

We express sincere thanks to Alexandra Klaser, Sabine Mattil, Tanja 
Metzger, Monjuri Paul, Pia Saar-Schneider, Gisela Wagner, and espe- 
cially Brigitte Schild for their help in compiling the CT and MR images. 
We also thank our colleagues Dr. Markus Bach, Dr. Christoph Buntru, Dr. 
Wolfgang Theobald, Dr. Albert Schmitt, Dr. Karl-Ernst Schmitt, Dr. Heike 
Rochelmayer, Dr. Pattrick Rosar, Dr. Lutger Henke, Dr. Klaus Kuhnen, and 
Dr. Christa Weller-Schweizer for their help and many suggestions, 
which helped see the book to its completion. 

Dillingen, 1999 Torsten B. Moeller 

Emil Reif 



Moeller, Normal Findings in CT and MRI © 2000 Thieme 

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Table of Contents 



Computed Tomography |l] 



CT: Head and Neck 

Neurocranium 

Pituitary 

Petrous pyramids . . 

Orbit 

Paranasal sinuses . . 
Cervical soft tissues 



CT: Chest 

Thoracic organs 

CT: Abdomen 

Upper abdominal organs 

Liver 

Pancreas 

Kidneys 

Adrenal glands 

Female pelvis 

Male pelvis 



CT: Spinal Column 

Cervical spine 

Thoracic spine 

Lumbar spine 



Magnetic Resonance Imaging 8a 

MRI: Head and Neck 8| 

Neurocranium 87^ 

Pituitary 9a 

Internal auditory canals, petrous pyramids 100 

Orbit M 

Paranasal sinuses 1 08 



Cervical soft tissues 112 



MRI: Chest hia 

Thoracic organs |118| 

Breast 125 



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VI Contents 



MRI: Abdomen 

Upper abdominal organs 

Liver 

Kidneys 

Adrenal glands 

Female pelvis 

Male pelvis 

Testes 



128 



128 



134 



140 



145 



150 



155 



159 



MRI: Spinal Column 

Cervical spine 

Thoracic spine 

Lumbar spine 

Sacroiliac joints 



162 



162 



168 



172 



178 



MRI: Joints 

Temporomandibular joint 

Shoulder joint 

Elbow joint 

Wrist 



183 



183 



186 



191 



Hip joint 200 



Knee joint 204 



Ankle and subtalar joints 211 



195 



MRI: Special Investigations 217 



Cranial vessels 217 



Cranial venous vessels 220 



MR angiography of the renal arteries 223 



Pelvic and lower limb vessels 227 



MR cholangiopancreatography 231 



Cervical arteries 234 



References 237 



Index 241 



Moeller, Normal Findings in CT and MRI © 2000 Thieme 

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Computed Tomography 



Moeller, Normal Findings in CT and MRI © 2000 Thieme 

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CT: Head and Neck 



Neurocranium 

The interhemispheric fissure is centered on the midline. The cerebrum 
and cerebellum show normal cortical sulcation. 
The cerebral ventricles are of normal size and symmetrically arranged. 
There are no signs of increased intracranial pressure. 
Normal development of the white matter and cortex, with normal den- 
sity of the periventricular white matter. 

The basal ganglia, internal capsule, corpus callosum, and thalamus ap- 
pear normal. 

The brain stem and cerebellum, if evaluable, also appear normal. 
Sella and pituitary are normal. Parasellar structures are unremarkable. 
There are no abnormalities in the cerebellopontine angle areas on both 
sides. 

The paranasal sinuses and mastoid air cells are normally developed, 
clear, and pneumatized. The orbital contents are unremarkable. There 
are no abnormalities in the calvarium. 

Interpretation 

Normal cranial CT. 



Checklist 

Interhemispheric 
fissure 



Cortical 
sulcation 



Centered on the midline 
No displacement 
Falx cerebri: 

— Width 

— Density (no calcifications) 

Of cerebrum and cerebellum (arbor vitae): 

— Configuration 

— Number of sulci 

— Width of sulci 

— No coarsening of sulci 

— No circumscribed narrowing or expansion 

— Well-defined cisterns and cortical markings 



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4 CT: Head and Neck 



Cerebral cortex 



Ventricles 



White matter 



Basal ganglia, 
internal and 
external capsule, 
thalamus 
Corpus callosum 



Brain stem 



Cerebellum 



Intracranial 
vessels 



Sella and 
pituitary 



Width 

Distribution (no ectopic tissue) 
Density (see below), no calcifications or hemor- 
rhages 

No separation from the calvarium 
No abnormal fluid collection (convex or concave) 
between the cerebral cortex and calvarium 
Shape 

Size appropriate for age (see below) 
Symmetry (no unilateral or circumscribed en- 
largement) 

No signs of increased intracranial pressure (e.g., 
effaced sulci, narrowing or unilateral expansion 
of ventricles) 

Density (homogeneous, especially at peri- 
ventricular sites— see below) 
No hypodensities (circumscribed, lacunar, or dif- 
fuse) 

No hyperdense changes (calcification, hemor- 
rhage) 

Normal width in relation to cortex 
Position 
Size 

Delineation 
Density 
Configuration 
Size 
Density 
Shape 

Density (homogeneous) 
No focal abnormalities 
General form (symmetry) 
Cortex (width, sulcation) 
White matter (homogeneous density) 
Course 
Width 

No abnormal dilatation 
No vascular malformations 
Size (see below) 
Configuration 
Density 
Borders 
Parasellar structures 



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Neurocranium 5 



Petrous pyramids • 



Paranasal sinuses • 



Orbit 



Calvarium 



Cerebellopontine angle area: 

— Width and symmetry of bony portions of in- 
ternal auditory canals (see below) 

— CSF spaces symmetrical and of normal size, 
no masses 

Mastoid air cells, mastoid antrum 

— Anatomy 

— Pneumatization 

— Borders (wall thickness, smooth contours 
with no discontinuities) 

— No masses 

— No fluid-dense opacification 
Cochlea and semicircular canals: 

— Anatomy 

— Configuration 

— Smooth borders 
Anatomy 
Pneumatization 

Borders (wall thickness, smooth and continuous 

contours) 

Nasal cavity: 

— Pneumatization 

— Septum on midline 

— Turbinates (presence of superior, middle, and 
inferior turbinates; width) 

Configuration of orbital cone 
Contents: 

— Globe (position— see below; size, density, 
wall thickness) 

— Eye muscles (position, course, density, width) 

— Optic nerve (course, width— see below) 

— Ophthalmic vein (course, width— see below) 
Configuration 

Contours (smooth, sharp, no expansion or bony 
outgrowths, no osteolytic or osteoplastic areas) 



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6 CT: Head and Neck 



Important Data 

Normal attenuation values: White matter Cortex 

• Noncontrast: 39 HU 32 HU 

• Postcontrast: 41 HU 33 HU 
(Each value has a deviation of ± 2 HU [Hounsfield units].) 
Attenuation difference between cortex and white matter: ap- 
proximately 7 HU 

Ventricular dimensions 

1 Cella media index: 

• B/A>4 = normal 

2 Frontal horn of lateral ventricle (at level of foramen of 
Monro): 

• Under age 40: < 12 mm 

• Over age 40: < 15 mm 

3 Width of third ventricle: 

• < 5 mm in children (slightly more in infants) 

• < 7 mm in adults under age 60 

• < 9 mm in adults over age 60 

4 Width of ophthalmic vein: 

• 3-4 mm 

5 Optic nerve (axial plane): 

a Retrobulbar segment: 5.5 mm ± 0.8 mm 
b Narrowest point (at approximately midorbit): 4.2 mm ± 
0.6 mm 

6 Position of globe: 

• Posterior margin of globe is 9.9 mm ± 1.7 mm behind the in- 
terzygomatic line 

Pituitary: Height of pituitary in sagittal reconstruction: 2-7 mm 
Caution: normal size variations during: 

— Pregnancy: up to 12 mm 

— Puberty: up to 10 mm in girls, up to 8 mm in boys 
Internal auditory canal: 5-10 mm (average 7.6 mm); should be < 
1 mm difference between the right and left sides 



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Neurocranium 7 




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8 CT: Head and Neck 




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Neurocranium 9 




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10 CT: Head and Neck 



Pituitary 

The sella shows normal size, position, and configuration. The borders of 
its floor and walls are smooth and sharply defined. 
The pituitary shows normal position, shape, and size. The pituitary 
tissue shows normal, homogeneous density both before and after con- 
trast administration. It contains no circumscribed hypodense or hyper- 
dense areas. 

The infundibulum is centered and of normal size. 
The optic chiasm and suprasellar CSF spaces appear normal. The 
cavernous sinus and imaged portions of the internal carotid artery and 
carotid siphon are unremarkable. 

Evaluable portions of the neurocranium show no abnormalities. 
The sphenoid sinus is clear and pneumatized. 



Interpretation 

The pituitary appears normal. 



Important Data 

1 Pituitary: 

a Height (in the midcoronal plane): 2-7 mm 
Caution: allow for normal size variations during: 

• Pregnancy: up to 12 mm 

• Puberty: up to 10 mm in girls, up to 8 mm in boys 

b Width (transverse extent in coronal plane, women of child- 
bearing age): 12.9 mm ± 1.6 mm 
Area of the pituitary in the coronal plane (height x width, 
women of childbearing age): 93 mm 2 ± 1.6 mm 2 

2 Optic chiasm: 

• Coronal: a, width 9-18 mm; b, height 3-6 mm 

• Axial: c, width 12-27 mm; d, depth 4-9 mm 

3 Pituitary stalk: 

• < 4 mm 



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Pituitary 11 




Axial scan 



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12 CT: Head and Neck 



Checklist 
Sella 



Pituitary 



Infundibulum 
Optic chiasm 



Suprasellar CSF 
spaces (chias- 
matic cistern) 
Cavernous sinus 



Internal carotid 
artery 

(siphon area) 
Neurocranium 



Sphenoid sinus 



Position 

Configuration (U shape) 

Walls steep, not splayed, of normal size 

Normal width of floor and walls 

Borders smooth and sharp 

Position: 

— At the center of the sella 
Configuration: 

— Bean-shaped 

— Superior border straight or slightly concave 
(convex only during puberty or pregnancy) 

Size (see below) 
Density: 

— Pituitary tissue homogeneous on noncontrast 
scans 

— Homogeneous contrast enhancement 

— No circumscribed hypodense or hyperdense 
areas within the pituitary 

Position (centered) 

Size (see below) 

Position 

Size (see below) 

Symmetry 

Course of optic nerve 

Shape (symmetrical) 

Width (no circumscribed narrowing) 

Shape (symmetrical) 

Size (see below) 

No infiltration 

Size 

Course 

Density 

Temporal lobe 

Hypothalamus 

Floor of third ventricle 

Borders: smooth, normal width (especially of 

roof), contours 

Pneumatization 



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Petrous Pyramids 13 



Petrous Pyramids 

The petrous pyramids are normally developed and symmetrical. They 

have smooth, intact cortical margins and a normal trabecular structure. 

The internal auditory canal is smooth and sharply defined on each side, 

with normal shape and diameter. The cochlea and semicircular canals 

appear normal. The mastoid air cells are normally developed, clear and 

pneumatized. Their bony walls are of normal thickness. The tympanic 

cavity is normally developed, and the auditory ossicles have a normal 

appearance. 

Configuration of the cerebellopontine angle area on each side is normal, 

with clear delineation of the cerebellopontine angle cistern. The brain 

stem has normal configuration and CT density. 

The external auditory canal appears normal on each side. 

Other visualized portions of the neurocranium show no abnormalities. 



Interpretation 

Both petrous pyramids appear normal at CT. 



Checklist 

Petrous pyramids • 



Internal auditory 
canals 



Cochlea and 
semicircular 
canals 



Configuration 

Shape (triangular) 

Bilateral symmetry 

Delineation (cortical margins smooth and sharp) 

Trabecular internal structure (no fracture lines, 

no bone destruction or circumscribed hy- 

podense or hyperdense areas) 

Smooth, sharp boundary with the calvarium 

(sinodural angle) 

Shape 

Course 

Width (see below) 

Bony boundaries (smooth, sharp) 

Vestibulocochlear nerve (cranial nerve VIII) and 

facial nerve (cranial nerve VII), if visualized: 

— Width (uniform, no right-left disparity) 

— Enhancement characteristics (nonenhancing) 
Anatomy 

Configuration 
Smooth borders 



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14 CT: Head and Neck 



Mastoid 



Cerebellopontine 
angle area 



Tympanic cavity: 

— Anatomy 

— Shape 

— Borders 

— Pneumatization 

Auditory ossicles (malleus, incus, stapes: pre- 
sence, shape, relative positions in ossicular 
chain) 

Cellular anatomy (antrum, retrofacial cells, peri- 
tubal cells, peribulbar cells, marginal cells, ter- 
minal cells): 

— Cells small, large, or of mixed sizes; normal = 
uniform enlargement of cells from antrum to 
terminal cells) 

— Pneumatization 

— Borders (septal thickness, smooth contours 
with no discontinuities) 

— No masses 

— Not opacified by abnormal fluid or soft-tissue 
density 

Brain stem 

— Shape 

— Density (homogeneous) 

— No focal abnormalities 
Vestibulocochlear and facial nerve nuclei: 

— No hypodensity 

— No masses 

Entry sites of vestibulocochlear nerve (enters 
pons and medulla at lateral extension of medul- 
lopontine sulcus) and facial nerve: 

— Bilaterally symmetrical 
CSF spaces: 

— Cerebellopontine angle cistern (symmetrical, 
fluid density) 

— No masses 

— Well delineated 

— No vascular loop 
External auditory canals: 

— Anatomy 

— Course 

— Width 

— Borders 



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Petrous Pyramids 15 



Rest of 
neuro cranium 



CSF spaces 



Cerebrum (especially the temporal lobe) and 
cerebellum: 

— Configuration 

— Sulcation 

— Cortical markings (arbor vitae) well defined 

— Width of sulci 

— No circumscribed widening or narrowing 

— Homogeneous density of cortex and white 
matter (no hypodense or hyperdense 
changes) 

Prepontine cistern 
Fourth ventricle 



Important Data 

1 Internal auditory canal: 

• Approx. 5-10 mm, with ca. 1 mm difference between the 
right and left sides 




Axial scan through the internal auditory canal 



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16 CT: Head and Neck 




Axial scan for evaluating the auditory ossicles 




Coronal scan through the internal auditory canal 



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Orbit 17 



Orbit 



The orbits are symmetrical and of normal size, with normal develop- 
ment of the orbital cone. The configuration of the smooth, sharply de- 
fined orbital walls is normal. There are no foci of bone destruction and 
there is no circumscribed widening of bony or soft-tissue components 
of the orbital walls. 

The globes are symmetrical and show normal size and position. The 
ocular contents are of normal density. The ocular wall is smooth, 
sharply defined, and of normal thickness. The optic nerve shows a nor- 
mal course and caliber on each side. 

The eye muscles are normally positioned and display normal width and 
course. The retrobulbar fat and ophthalmic vein are unremarkable. 
Imaged portions of the neurocranium and paranasal sinuses show no 
abnormalities. 

Interpretation 

The orbit and its contents appear normal. 



Checklist 






Orbits < 


> Symmetrical 
» Normal size 
' Normal orbital cone 




Orbital walls • 


• Smooth, sharp borders 
' No bone destruction 






> No circumscribed widening of bone or soft- 




tissue components 




Globe 


> Position (see below) 
' Symmetry 
• Size (see below) 
» Spherical 




Ocular contents • 


' Density 




Ocular wall < 


> Borders (smooth and sharp) 
' Uniform thickness 




Optic nerve < 


> Normal caliber (see below) 
• Course 




Eye muscles < 


> Position 

> Width (see below) 
» Course 




Retrobulbar fat • 


> Clear 

' No masses 





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18 CT: Head and Neck 



Ophthalmic vein • 


> Course 




> Caliber (see below) 


Lacrimal gland • 


> Size 




» Symmetry 




» No unilateral or bilateral enlargement 




> Position (see below) 




> No excavation or destruction of adjacent bone 




> Homogeneous internal structure 




> No hypodense areas 




> Smooth borders 


Neurocranium • 


> Temporal lobes 




> Frontal lobes 


Paranasal • 


» Maxillary sinuses 


sinuses • 


> Ethmoid cells 




Axial scan 



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Orbit 19 



Important Data 

1 Diameter of globe: 

• Axial plane: 

- Right: 28.6 ± 1.2 mm 

- Left: 29.4 ± 1.4 mm 

• Sagittal plane (reconstruction): 

- Right: 27.8 ± 1.2 mm 

- Left: 28.2 ± 1.2 mm 

2 Position of globe: 

• Posterior margin is 9.9 mm ± 1.7 mm behind the interzygo- 
matic line 

3 Optic nerve (axial plane): 

a Retrobulbar segment: 5.5 mm ± 0.8 mm 
b Narrowest point (at approxinately mid-orbit): 4.2 mm ± 
0.6 mm 

4 Ophthalmic vein: 

• 1.8 mm ± 0.5 mm (axial plane, 4 mm slice thickness) 

• 2.7 mm ± 1 mm (coronal plane) 

5 Eye muscles 

a Superior rectus: 3.8 mm ± 0.7 mm 
b Oblique: 2.4 mm ± 0.4 mm 
c Lateral rectus: 2.9 mm ± 0.6 mm 
d Medial rectus: 4.1 mm ± 0.5 mm 
e Inferior rectus: 4.9 mm ± 0.8 mm 

Lacrimal gland: less than half of the gland is anterior to the fron- 
tozygomatic process. 



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20 CT: Head and Neck 




Axial scan 




Axial scan 



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Orbit 21 




Coronal scan 



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22 CT: Head and Neck 



Paranasal Sinuses 

The frontal sinuses are normally developed, clear and pneumatized 
with smooth wall contours. 

The ethmoid cells have a normal appearance and intact bony walls, 
especially on the orbital side. There are no areas of wall erosion or mu- 
cosal thickening. 

The sphenoid sinus is normally developed and has a coarse honeycomb 
structure. There are no fluid collections or mucosal swelling. 
The maxillary sinuses are bilaterally symmetrical and have smooth 
walls of normal thickness. The sinuses are clear and aerated with no 
bone destruction. The nasal septum is on the midline, and the turbi- 
nates are normally developed. 

The nasal cavity, pharynx, and imaged parapharyngeal structures show 
no abnormalities. 



Interpretation 

The paranasal sinuses appear normal. 



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Paranasal Sinuses 23 



Checklist 
Frontal sinuses 

Ethmoid cells 



Sphenoid sinus 



Maxillary 
sinuses 



Nasal cavity 



Pharynx and 

parapharyngeal 

structures 



Anatomy 

Wall contours (smooth) 
Pneumatization 
Anatomy 
Pneumatization 

Bony structures (especially bordering the orbit: 
boundaries are smooth, sharp, and intact) 
No wall erosions 
No mucosal thickening 
Anatomy (coarse honeycomb structure) 
Clear and pneumatized 
No fluid collection 
No mucosal swelling 

Bony structures (smooth, intact walls, no ero- 
sion) 

No extrinsic wall indentations 
Anatomy 

Size (bilaterally symmetrical) 
Bony structures (smooth, intact contours, walls 
of normal width, no bone erosion or destruction) 
Pneumatization 

No tooth roots projecting through maxillary 
sinus floor 

Anatomy (symmetry) 
Size 

Aeration (clear) 
Nasal septum on the midline 
Nasal turbinates (three on each side: superior, 
middle, inferior) are normally developed 
Anatomy (symmetry) 
Size 

Wall thickness 
No foreign bodies, calcifications, or masses 



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24 CT: Head and Neck 




Coronal scan 




Coronal scan 



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Paranasal Sinuses 25 



Important Data 

1 Frontal sinus: 

• Height ca. 1.5-2 cm 

2 Sphenoid sinus: 

• Width 0.9-1.4 cm 

3 Maxillary sinuses: 

a Width ca. 2 cm 
b Height ca. 2 cm 




Axial scan 




. KjP 

Axial scan 



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26 CT: Head and Neck 



Cervical Soft Tissues 

The cervical soft tissues show normal configuration, and the cervical 
spine is normally positioned. 

The oral floor muscles are bilaterally symmetrical and normally 
developed. The spaces of the oral floor and neck are clear and well de- 
fined. 

Imaged portions of the parotid and submandibular glands show no ab- 
normalities. 

The pharynx and larynx show normal boundaries and normal wall 
thickness. 

The thyroid gland shows reasonable symmetry and normal size. The 
thyroid lobes have a normal internal structure. 

Cervical vessels that can be evaluated with CT have a normal appear- 
ance. 

The muscular structures of the neck appear normal, and there are no 
signs of cervical lymphadenopathy. 



Interpretation 

The cervical soft tissues appear normal. 



Retropharyn 
geal space 

Posterior 
cervical space 

Perivertebral 
space 
(paraspina 
portion) 




Visceral space 

Anterior cer- 
vical space 
Carotid space 

Perivertebral 
space (pre- 
vertebral 
portion) 

Superficial 
space 



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Cervical Soft Tissues 27 



Checklist 

Cervical soft 
tissues 

Oral floor 
muscles 



Submandibular 
gland (and 
parotid gland) 



Pharynx and 
larynx 



Cervical spaces 



Esophagus 



Thyroid gland 



Configuration 

Normal anatomy 

Normal position of cervical spine 

Anatomy 

Width 

Bilateral symmetry 

Boundary definition 

Internal structure 

Spaces of oral floor are clearly defined 

Size (symmetry) 

Density 

No dilatation of glandular duct 

No hypodense or hyperdense areas within the 

glandular tissue 

Shape (symmetrical) 

Size 

Smooth walls 

Normal wall thickness 

No masses 

Retropharyngeal space 

Parapharyngeal space (visceral space) 

Carotid space 

Anterior and posterior cervical spaces 

Perivertebral space (prevertebral and paraspinal 

portions): 

— Configuration 

— Boundaries 

— Symmetry 

— Internal structure 

— Width (see below) 
Position 

Wall thickness (see below) 

Boundaries 

No masses 

Anatomy (two lobes, largely symmetrical) 

Size (see below) 

Internal structure (homogeneous) 

No cysts 

No nodules 

No calcifications 



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28 CT: Head and Neck 



Cervical vessels 



Neck muscles 



Lymph node 
stations 
Cervical spine 

(if e valuable) 



Course 

Caliber (see below) 

No abrupt caliber changes 

No calcifications 

Anatomy 

Symmetry 

Borders 

Internal structure 

No lymphadenopathy 

Vertebral bodies 

— Number 

— Shape 

— Position 

— Contours 

Intervertebral disk spaces 
Spinal canal: 

— Width 

— No circumscribed narrowing 
Normal width of cervical spinal cord 
No masses 

No narrowing 




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Cervical Soft Tissues 29 



Important Data 

Prevertebral soft tissues 

1 Retropharyngeal: ca. 1.7 ± 0.7 mm 

2 Retroglottic: ca. 6.0 ± 1.1 mm 

3 Retrotracheal: ca. 8.4 ± 2.5 mm 

Lumina of upper respiratory tract (normal respiration): 

4 Laryngeal inlet (hyoid level): ca. 19 ± 4 mm 

5 Glottis: ca. 21 ± 4 mm 

6 Trachea: ca. 17 ± 3 mm 

7 Thyroid dimensions: 

a Length: 3.6-6 cm (reconstruction) 
b Width: 1.5-2 cm 
c Depth: 1-2 cm 
Vascular calibers (at level of thyroid gland) 

8 Common carotid artery: 6-10 mm 

9 Esophagus: wall thickness 3 mm 




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30 CT: Head and Neck 




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31 

CT: Chest 



Thoracic Organs 

Both lungs are normally aerated and are applied to the chest wall on all 
sides. There is no sign of circumscribed pleural thickening and no fluid 
collection. 

Pulmonary structure is normal and shows normal vascular markings. 
There are no intrapulmonary nodules or patchy opacities. 
The mediastinum is centered and of normal width. There is no evidence 
of masses in the anterior, central, or posterior compartments. 
The hilar region on each side is unremarkable, and the main bronchi ap- 
pear normal. 

The heart is orthotopic with normal configuration. The cardiac cham- 
bers are of normal size. 

Major intrathoracic vessels and imaged portions of the supra-aortic ves- 
sels are unremarkable. 
The thoracic skeleton and thoracic soft tissues show no abnormalities. 

Interpretation 

The thoracic organs appear normal at CT. 



Checklist 

Lungs • Anatomy (paired and symmetrical) 

• Fully apposed to the chest wall 

• No pleural thickening 

• No wall thickening 

• No fluid collection (patchy or circumscribed) 

• Complete aeration 

• Normal attenuation values of lung parenchyma 
(see below) 

• Pulmonary structure 

• Vascular markings (diminish from center to pe- 
riphery) 

• No pulmonary nodules 

• No patchy opacities (e.g., plaques or infiltrates) 



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32 CT: Thorax 



Mediastinum 



Vessels 



Diaphragm 



Thoracic skeleton • 
(ribs, clavicle, • 
sternum, scapula) • 



Thoracic soft 
tissues 



Configuration, position: 

— Centered 

— Width (see below) 

— No masses in the anterior, central, or poste- 
rior compartment 

Hilar region: 

— No masses or lymphadenopathy 
Main bronchi: 

— Anatomy 

— Course 

— Width (see below) 
Heart: 

— Position (centered slightly left of midline) 

— Configuration 

— Size (cardiac chambers— see below) 

— Myocardium (width— see below) 
Intrathoracic vessels (ascending aorta, aortic 
arch, descending aorta, vena cava— see below): 

— Anatomy 

— Size 

Supra-aortic vessels (subclavian artery, brachio- 
cephalic trunk, left common carotid artery): 

— Anatomy 

— Size 

Shape (no contour abnormalities, costophrenic 

angle is sharp and clear) 

Position (approximately the level of the 10th- 

11th posterior rib) 

Width (no circumscribed widening, no defect) 

Position 

Structure 

Contours and symmetry 

No bony expansion or destruction 

Thoracic spine: 

— Position 

— Shape of thoracic vertebrae 
Configuration 

Width 

Symmetry 

Density 



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Thoracic Organs 33 



Important Data 

1 CT density of lung parenchyma: 

• -403 ± 25 HU 

2 Diameter of aorta: 

• <4cm 

a Ascending aorta: 

• At level of pulmonary trunk bifurcation: 3.2 cm ± 0.5 cm 

• At level of aortic root: 3.7 cm ± 0.3 cm 
b Descending aorta: 

• 2.5 cm ± 0.4 cm 

• Aortic arch: 1.5 cm ± 1.2 cm 

Ratio of ascending to descending aortic diameters = 1.5:1 

3 Diameter of superior vena cava: 

• At level of aortic arch: 1.4 cm ± 0.4 cm 

• At level of pulmonary trunk bifurcation: 2 cm ± 0.4 cm 

4 Diameter of pulmonary arteries: 

• Pulmonary trunk: 2.4 cm ± 0.2 cm 

• Proximal right pulmonary artery: 1.9 cm ± 0.3 cm 

• Distal right pulmonary artery: 1.5 cm ± 0.3 cm 

• Left pulmonary artery: 2.1 cm ± 0.4 cm 

5 Width of main bronchi: 

• Right ca. 15 mm 

• Left ca. 13 cm 

6 Mediastinum: 

• Transverse diameter of thymus: 1-2 cm 

Heart 

Dimensions of cardiac chambers 

7 Right atrium: 

• Maximum transverse diameter: 4.4 cm 

— At level of aortic root: 1.9 cm ± 0.8 cm 

— At level of mitral valve: 3.2 cm ± 1.2 cm 

— At center of ventricles: 2.8 cm ± 0.4 cm 

8 Left atrium: 

a Maximum anteroposterior diameter: 4-5 cm 

• At level of aortic root: 2.4 cm ± 4.5 cm 

• At level of mitral valve: 2.9 cm ± 4.9 cm 
b Maximum transverse diameter: 9 cm 

• At level of aortic root: 5.5 cm ± 8.4 cm 

• At level of mitral valve: 4.9 cm ± 9.1 cm 

9 Angle between midsagittal plane and septum = 38° 



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34 CT: Thorax 



10 Thickness of ventricular septum: 

• Approximately 5-10 mm 

11 Thickness of pericardium: 

• 1-2 mm 

12 Thickness of myocardium: 

• 10-12 mm 




Lung window 




-5b 



Contrast bolus scan at level of pulmonary trunk bifurcation 



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Thoracic Organs 35 




Contrast bolus scan at level of aortic root 




Contrast bolus scan through center of ventricles 



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36 

CT: Abdomen 



Upper Abdominal Organs 

The liver is normally positioned and has normal size and smooth 
borders. 

Its internal structure and attenuation values are normal. The intrahe- 
patic and extrahepatic bile ducts and gallbladder are unremarkable. 
The spleen is orthotopic and of normal size. It has smooth outer con- 
tours and a homogeneous internal structure. 

The pancreas is normal in size, position, and internal structure with 
smooth, lobulated outer contours. The pancreatic duct is unobstructed. 
Both kidneys show normal size and position. The renal parenchyma 
shows normal width and structure. 

The renal pelvis and calices show a normal configuration. The urinary 
drainage tract is unobstructed. 
The adrenal glands are unremarkable. 

Major blood vessels appear normal, and there is no evidence of lym- 
phadenopathy. 
Imaged portions of the lung and soft tissues are normal. 

Interpretation 

The upper abdominal organs appear normal at CT. 



Checklist 

Liver • Position 

— Directly below the right hemidiaphragm 

• Size (see below) 

• Borders: 

— Smooth 

— Sharp 

• Normal attenuation values (see below) 

• Homogeneous internal parenchymal structure 

• No focal abnormalities 

• Intrahepatic bile ducts: 

— Course (centrifugal) 

— Width (general rule: ducts should no longer 



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Upper Abdominal Organs 37 



Spleen 



Pancreas 



Kidneys 



be visible after contrast administration— see 
below) 

— No calculi 

— No air 
Extrahepatic bile ducts: 

— Course (from porta hepatis to head of pan- 
creas) 

— Width (see below) 

— Contents of homogeneous fluid density 

— No calculi 

— No air 
Gallbladder: 

— Size (see below) 

— Smooth outer contours 

— Normal wall thickness (see below) 

— No pericholecystic fluid 
Gallbladder contents: 

— Homogeneous 

— Fluid density 

— No calculi (hypodense or hyperdense) 

— No air 

Porta hepatis occupied by the hepatic artery, 

common bile duct, and portal vein 

No masses 

No lymphadenopathy 

Costophrenic sinus clear and aerated on both 

sides 

Size (see below) 

Smooth outer contours 

Homogeneous internal structure 

Attenuation values (see below) 

Size normal for age (see below) 

Normal lobulation 

Smooth outer contours 

Pancreatic duct unobstructed 

No peripancreatic fluid 

Normal para-aortic region 

Paired 

Position (see below) 

Size (see below) 

Smooth contours 

Width of parenchyma (see below) 

Density (see below) 



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38 CT: Abdomen 



Ureters 



Adrenal glands 



Intestinal 
structures (colon 
haustrations, 
small bowel) 



Major vessels 



Lymph node 
stations (espe- 
cially retrocrural, 
mesenteric, 
paraaortic) 
Lung segments 



Soft tissues 



Width of cortex and medulla 
Renal pelvis (anatomy, symmetry, size, no widen- 
ing, contents of homogeneous fluid density) 
Calices (shape, width, homogeneous contents) 
Enhancement characteristics (see below) 
Not duplicated 
Course 

No obstruction of urinary drainage 
Normal-appearing periureteral fat 
Near-simultaneous opacification of both ureters 
after contrast administration 
Shape 

Size (see below) 
Slender crura 

No circumscribed hypodense (cyst, adenoma), 
isodense or hyperdense expansion 
Anatomy 
Shape 

Wall thickness 

Homogeneous opacification after oral contrast 
administration 

No free extraintestinal or intra-abdominal air or 
fluid 
Position 

Size (see below) 

Luminal opacification after contrast administra- 
tion 

No large (intimal) calcifications 
No mural thrombosis 
No dissection 
No lymphadenopathy 



Configuration 

Complete aeration 

No adhesions 

No pulmonary nodules 

Anatomy 

Symmetry 

Density 



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Upper Abdominal Organs 39 



Important Data 

Dimensions: 

1 Liver: 

a Angle of left hepatic border: ca. 45° 
b Left lobe (anteroposterior diameter measured on the para- 
vertebral line): up to 5 cm 

• Caudate lobe/right lobe (CL/RL) = 0.37 ± 0.16 (e.g., 0.88 ± 0.2 in 
cirrhosis) 

2 Spleen: 

a Depth (D): 4-6 cm 

b Width (W): 7-10 cm 

c Length (L): 11-15 cm (reconstruction) 

Splenic index: DxWxL = between 160 and 440 

3 Pancreas: 

a Head up to 3.5 cm 
b Body up to 2.5 cm 
c Tail up to 2.5 cm 

4 Adrenal glands (variable): 

• Crural thickness < 10 mm 

5 Gallbladder: 

a Horizontal diameter up to 5 cm (> 5 cm is suspicious for hy- 
drops) 
b Width of gallbladder wall: 

• 1-3 mm 

c Width of common bile duct: 

• < 8 mm (after cholecystectomy: < 10 mm) 

6 Inferior vena cava: 

• Transverse diameter up to 2.5 cm 

7 Abdominal aorta: 

• Transverse diameter ca. 18-30 mm 

8 Kidneys: 

a Anteroposterior diameter ca. 4 cm 

b Transverse diameter 5-6 cm; craniocaudal diameter 

(= highest to lowest section) 8-13 cm 
c Transverse renal axis: posteriorly divergent angle of 120° 
d Width of renal cortex: 4-5 mm 
e Width of ureter: 4-7 mm 

Position of superior poles of kidneys: 

• Right: superior border of LI 

• Left: inferior border of T12 



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40 CT: Abdomen 



Time to corticomedullary equilibrium: 

• 1 minute 

Contrast excretion into the pyelocaliceal system: 

• 3 minutes 

Gerota fascia (thickness): 

• 1-2 mm 

Lymph nodes larger than 1 cm are suspicious for pathology. 
Attenuation values: 

• Liver: 65 ± 10 HU 

• Spleen: 45 ± 5 HU 

• Pancreas: 40 ± 10 HU 

• Fat: -65 to -100 HU 

• Kidneys: 30-45 HU without contrast medium; renal cortex 
after contrast medium: approx. 140 HU 

• Adrenal glands: 25-40 HU without contrast medium 

• Muscle: 45 ± 5 HU 

• Blood vessels: approx. 40-55 HU without contrast medium 

• Gallbladder contents: 0-25 HU 




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Upper Abdominal Organs 41 




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42 CT: Abdomen 




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Upper Abdominal Organs 43 




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44 CT: Abdomen 



Liver 

The liver is orthotopic and of normal size, with smooth borders and nor- 
mal attenuation values. It presents a normal internal structure with no 
focal abnormalities. 

The intrahepatic and extrahepatic bile ducts are normal in their course, 
width, and contents. 

The gallbladder appears normal, presenting smooth borders and homo- 
geneous contents. 

The porta hepatis shows no abnormalities. 
Other visualized upper abdominal organs are unremarkable. 



Interpretation 

The liver appears normal at CT. 



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Liver 45 



Checklist 

Liver • Position: 

— Directly below the right hemidiaphragm 

• Size (see below) 

• Borders: 

— Smooth 

— Sharp 

• Attenuation values (see below) 

• Homogeneous internal parenchymal structure, 
no focal abnormalities 

• Intrahepatic bile ducts: 

— Course (centrifugal) 

— Width (general rule: ducts should no longer 
be visible after contrast administration) 

— No calculi 

— No air 

• Extrahepatic bile ducts: 

— Course (from porta hepatis to head of pan- 
creas) 

— Width (see below) 

— Contents of homogeneous fluid density 

— No calculi 

— No air 

• Gallbladder: 

— Size (see below) 

— Contours (smooth and sharp) 

— Wall thickness (see below; no general or cir- 
cumscribed thickening) 

— No pericholecystic fluid 

• Gallbladder contents: 

— Homogeneous 

— Fluid density (see below) 

— No calculi (hypodense or hyperdense) 

— No air 

— Porta hepatis occupied by the hepatic artery, 
common bile duct, and portal vein; no masses 
or lymphadenopathy 

— Costophrenic sinus clear and aerated on both 
sides; no pleural effusion, no infiltrates, no 
masses 



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46 CT: Abdomen 



Spleen 



Pancreas 



Adrenal glands, 
kidneys (if 
visualized) 
Abdominal cavity 



Soft tissues 



Position 

Configuration 

Size (see below) 

Density (homogeneous internal structure) 

Contours (smooth) 

Position 

Configuration 

Size 

Density (homogeneous internal structure) 

Contours (smooth, lobulated) 

Pancreatic duct 

Para-aortic region unremarkable 

Position 

Size (see below) 

Internal structure 

Intestinal structures (if visualized and evaluable: 

configuration, width, wall thickness) 

No free extraintestinal or intra-abdominal air or 

fluid 



Important Data 

Dimensions 

1 Liver: 

a Angle of left hepatic border: ca. 45° 

b Caudate lobe/right lobe (CL/RL) = 0.37 ± 0.16 (e.g., 0.88 ± 0.2 
in cirrhosis. Reference lines [from medial side]: line I is tan- 
gent to the medial border of the caudate lobe; line II is paral- 
lel to I and tangent to the lateral aspect of the portal vein; 
line III is tangent to the lateral hepatic border and perpen- 
dicular to a line midway between the portal vein and infe- 
rior vena cava and perpendicular to I and II. 

c Left lobe (anteroposterior diameter measured on the para- 
vertebral line): up to 5 cm 

2 Portal vein: 

• Up to 1.5 cm 

3 Hepatic veins: 

• Up to 0.5 cm 



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Liver 47 

Gallbladder: 

• Horizontal diameter up to 5 cm (> 5 cm is suspicious for hy- 
drops) 

Width of gallbladder wall: 

• 1-3 mm 
Width of common bile duct: 

• < 8 mm (after cholecystectomy: < 10 mm) 
Spleen: 

• Depth (D): 4-6 cm 

• Width (W): 7-10 cm 

• Length (L): 11-15 cm 

• Splenic index: DxWxL = 160-440 
Kidneys: 

• Craniocaudal diameter: 8-13 cm 

• Anteroposterior diameter: ca. 4 cm 

• Transverse diameter 5-6 cm 
Position of superior poles: 

• Right: superior border of LI 

• Left: inferior border of T12 
Width of renal cortex: 

• 4-5 mm 
Gerota fascia (thickness): 

• 1-2 mm 
Adrenal glands (variable): 

• Crural thickness < 10 mm 
Diameter of abdominal aorta: 

• Approximately 18-30 mm 

Lymph nodes larger than 1 cm are suspicious for pathology. 
Attenuation values 

• Liver: 65 ± 10 HU 

• Gallbladder contents: 0-25 HU 

• Spleen: 45 ± 5 HU 

• Pancreas: 40 ± 10 HU 

• Fat: -65 to -100 HU 

• Kidneys: 35-45 HU without contrast medium 

• Adrenal glands: 25-40 HU without contrast medium 

• Muscle: 45 ± 5 HU 

• Blood vessels: ca. 40-55 HU without contrast medium 



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48 CT: Abdomen 




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Liver 49 




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50 CT: Abdomen 



Pancreas 

The pancreas is orthotopic and presents a normal size and smooth 
borders. 

Lobulation of the pancreas is normal and appropriate for age. The 
parenchyma shows normal internal structure and attenuation values 
with no hypodense or hyperdense intrapancreatic changes. The pan- 
creatic duct shows normal course and caliber. 

The duodenal colon is unremarkable. The common bile duct is of nor- 
mal width and has an unobstructed, fluid-filled lumen. 
The visualized intrahepatic and extrahepatic bile ducts appear normal. 
No abnormalities appear in the peripancreatic fat. 
The splenic vein and mesenteric vessels appear normal. The mesenteric 
root is normal. 

Imaged portions of the liver, spleen, kidneys, and adrenals are unre- 
markable, as are the pararenal and paracolic spaces. 
The major vessels appear normal, and there are no signs of lymphade- 
nopathy. 



Interpretation 

The pancreas appears normal at CT. 



Checklist 

Pancreas • Position 

• Configuration 



Size appropriate for age (see below) 

Normal lobulation (borders are usually straight 

in adolescents and show increased lobulation 

with aging) 

Smooth outer contours 

Internal parenchymal structure (homogeneous 

in young patients, becomes slightly nonhomo- 

geneous with aging) 

No focal abnormalities (e.g., calcifications, cysts, 

tumors) 

Pancreatic duct: 

— Position (centered in the pancreas) 

— Width (see below) 

— No obstruction 

— No circumscribed or beaded dilatation or nar- 
rowing 



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Pancreas 51 



— Termination (usually opens into duodenum at 
Vater papilla with intrapancreatic part of 
common bile duct) 

• No peripancreatic fluid (exudate tracks along the 
left and right pararenal spaces, into the omental 
bursa, and along the paracolic gutters) 

• Para-aortic region 

• Splenic vein: 

— Course (lies against posterior surface of 
pancreas, runs from splenic hilum to portal 
vein) 

— Width 

• Lymph nodes (especially the parapancreatic and 
pancreaticosplenic stations): 

— Size 

— Number 

• Peripancreatic fat: 

— Fat attenuation 

— No infiltration 

— No fluid 

• Mesenteric artery and vein: 

— Course 

— Size 

• Duodenum (descending part: directly adjacent 
to head of pancreas; horizontal part: directly ad- 
jacent to uncinate process) 

• Transverse mesocolon 

• Stomach: 

— Smooth posterior surface 

— Normal wall thickness 

— Surrounded by fatty tissue 

• Extrahepatic bile ducts: 

— Course (from porta hepatis to head of pan- 
creas) 

— Width (see below) 

— Contents of homogeneous fluid density 

— No calculi 

— No air 
Liver • Position 

• Size (if evaluable) 

• Borders 

— Smooth 

— Sharp 



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52 CT: Abdomen 



Spleen 



Kidneys 



Adrenal glands 



Intestinal 
structures (colon 
haustrations, 
small bowel) 

Blood vessels 
(aorta, inferior 
vena cava) 
Lymph node 
stations (para- 
aortic, retro- 
crural) 



Attenuation values (see below) 
Homogeneous internal parenchymal structure 
Intrahepatic bile ducts 

— Course (centrifugal) 

— Width (general rule: should no longer be vis- 
ible after contrast administration) 

Gallbladder (if visualized): 

— Size 

— Contents 

— Wall thickness 

Porta hepatis occupied by the hepatic artery, 
common bile duct, and portal vein; no masses or 
lymphadenopathy 
Position 
Size 
Borders 

Density (see below) 
Paired 
Position 
Size 

Smooth contours 
Width of parenchyma 
Density (see below) 
Shape 

Size (see below) 
Symmetrical crura 
No circumscribed expansion 
Normal wall thickness 

Homogeneous opacification by oral contrast me- 
dium 

No free extraintestinal or intra-abdominal air or 
fluid 
Size 
No luminal obstruction 

No lymphadenopathy 



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Pancreas 53 



Important Data 

Dimensions of pancreas (normal ranges for age): 



Age (years) 


Headl 


(mm) 


Body 2 (mm) 


Tail 3 (mm) 


• 20-30 


25-32 






17-21 


16-20 


• 31-40 


23-29 






16-20 


15-18 


• 41-50 


22-29 






16-19 


14-17 


• 51-60 


21-27 






14-18 


14-17 


• 61-70 


20-26 






14-18 


13-16 


• 71-80 


17-25 






12-17 


11-15 


Rule of thumb 


head < 


3.5 


cm 


body and tail < 


2.5 cm 



4 Pancreatic duct: 

Width 1-3 mm 
Width of common bile duct: 

< 8 mm (< 10 mm after cholecystectomy) 
Attenuation values: 

Pancreas: 40 ± 10 HU 
Liver: 65 ± 10 HU 
Spleen: 45 ± 5 HU 

Kidneys: 35-45 HU without contrast medium; renal cor- 
tex after contrast medium: ca. 140 HU 
Adrenal glands: 25-40 HU without contrast medium 
Muscle: 45 ± 5 HU 

Blood vessels: ca. 40-55 HU without contrast medium 
Gallbladder contents: 0-25 HU 
Fat: -65 to -100 HU 
Dimensions: 

Spleen: width 7-10 cm, height 4-6 cm, length 11-15 cm 

Adrenal glands (variable): crural thickness < 10 mm 

Gallbladder: horizontal diameter up to 5 cm (> 5 cm is 

suspicious for hydrops) 

Width of gallbladder wall: 1-3 mm 

Gerota fascia (thickness): 1-2 mm 

Diameter of abdominal aorta: approx. 18-30 mm 

Lymph nodes larger than 1 cm are suspicious for 

pathology. 



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54 CT: Abdomen 




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Pancreas 55 




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56 CT: Abdomen 



Kidneys 

Both kidneys appear normal in size and position, with normal width 
and density of the renal parenchyma. There is no evidence of a mass. 
The calices are of normal shape. The renal pelvis is normal and free of 
stones, and there is no obstruction of urinary drainage. 
Contrast-enhanced scans show a normal time to corticomedullary equi- 
librium and timely, symmetrical contrast excretion into the renal pelves 
with no filling defects. 

The perirenal and pararenal spaces are unremarkable. 
Other visualized upper abdominal organs, especially the adrenal glands, 
show no abnormalities. 



Interpretation 

Both kidneys appear normal at CT. 



Checklist 
Kidneys 



Anatomy: 

— Paired 

— Position (see below) 

— Size (see below) 
Organ contours: 

— Smooth and sharp 
Width of parenchyma 
Density (see below) 

Normal relation of cortex to medulla 
Renal pelves: 

— Structure and shape of caliceal groups 

— Bilateral symmetry 

— No expansion 
Ureters: 

— One per side 

— Course 

— Width (see below) 

— No obstruction 

Peri- and pararenal spaces: 

— Fat attenuation 

— No masses 

— No increase in soft-tissue structures 

— No fluid 



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Kidneys 57 



Adrenal glands 



Retroperitoneal 
space 
Intestinal 
structures 



Vessels 



Soft tissues 



Peri- and pararenal fasciae: 

— Course 

— Width (no diffuse or circumscribed thicken- 
ing) 

Shape 

Size (see below) 

Slender crura 

No circumscribed expansion 

No mass, fluid, or increased density 

Colon haustrations, small bowel 

Wall thickness 

Homogeneous contrast enhancement 

No free extraintestinal or intra-abdominal air or 

fluid 

Course 

Size (see below) 

No lymphadenopathy (see below) 

Density 

Symmetry 

Muscles (size, internal structure, borders) 

Fat (density, no soft-tissue or fluid infiltration) 



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58 CT: Abdomen 



Important Data 

1 Distance between renal poles: 

• Superior poles: ca. 10 cm (4-16 cm) apart 

• Inferior poles: ca. 13 cm (9-18.5 cm) apart 

2 Transverse renal axis: 

• Posteriorly divergent angle of 120° 

3 Transverse renal diameter at level of hilum: 

• 5-6 cm (a, transverse) x 3-4 cm (b, anteroposterior) 

4 Width of cortex: 

• 4-5 mm 

5 Width of ureter: 

• 4-7 mm 

6 Gerota fascia (thickness): 

• 1-2 mm 

Position of superior poles of kidneys: 

• Right: superior border of LI 

• Left: inferior border of T12 (variable; note that the differ- 
ence does not exceed 1.5 vertebral body heights) 

Renal dimensions: 

• Craniocaudal (= highest to lowest section!) 8-13 cm 
Right-left disparity in renal sizes: 

• Craniocaudal < 1.5 cm 
Renal attenuation values: 

• 35-45 HU without contrast medium 

• Renal cortex ca. 140 HU after contrast administration 
Time to corticomedullary equilibrium: 

• 1 minute 

Contrast excretion into the pyelocaliceal system: 

• 3 minutes 

7 Size of adrenal glands (variable): 

• Crural thickness < 10 mm 

Density of normal adrenal glands: 25-40 HU without contrast 
medium 

8 Abdominal aorta: 

• Transverse diameter ca. 18-30 mm 

9 Inferior vena cava: 

• Transverse diameter up to 2.5 cm 

Vascular density: ca. 40-55 HU without contrast medium 
Lymph nodes larger than 1 cm are suspicious for pathology. 



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Kidneys 59 




Early bolus phase 




Early bolus phase 



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60 CT: Abdomen 




Late phase with corticomedullary equilibrium and opacification of the renal 
pelvis 




1b 



Late phase with ureteral opacification 



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Adrenal Glands 61 



Adrenal Glands 

Both adrenal glands present normal size and position with normally 

developed crura. There is no evidence of a mass and no circumscribed 

expansion. 

The adrenal compartment is unremarkable. 

Postcontrast scans show normal adrenal enhancement characteristics 

and dynamics. 

Other visualized upper abdominal organs, especially the kidneys, show 

no abnormalities. 

Interpretation 

Both adrenal glands appear normal at CT 



Checklist 

Adrenal glands • 



Liver 



Spleen 



Pancreas 



Paired 

Position (superior and anterior to the kidneys) 

Shape 

Size (see below) 

Borders (smooth, sharp) 

Slender adrenal crura showing no circumscribed 

hypodense, isodense, or hyperdense expansion 

No calcifications 

Adrenal compartment: 

— Fat attenuation 

— No mass 
Enhancement characteristics: 

— Uniform increase in density 

— No hypodense or hyperdense lesions within 
the adrenal crura 

Size (see below) 
Borders: 

— Smooth 

— Sharp 

Homogeneous internal parenchymal structure 
Intrahepatic and extrahepatic bile ducts 
Costophrenic sinus clear and aerated on each side 
Size (see below) 
Smooth outer contours 
Homogeneous internal structure 
Size 
Pancreatic duct 



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62 CT: Abdomen 



Kidneys 



Stomach and 
bowel 



Major vessels 

Lymph nodes 
Diaphragm 



Vertebral bodies 
Soft tissues 



Paired 

Position (see below) 

Size (see below) 

Smooth contours 

Position 

Size 

No masses 

No infiltration 

Transverse diameter 

Flow 

No lymphadenopathy 

No circumscribed widening 

Lungs in the costophrenic sinus (no effusion or 

opacities) 

Margins, bony structure 



Important Data 

Dimensions 

1 Adrenal glands (variable): 

• Crural thickness < 10 mm 

• Density (without contrast medium): 25-40 HU 
Position of superior poles of kidneys: 

• Right: superior border of LI 

• Left: inferior border of T12 
Transverse renal axis: 

• Posteriorly divergent angle of 120° 
Renal dimensions: 

• Craniocaudal: 8-13 cm 

• Anteroposterior: ca. 4 cm 

• Transverse: 5-6 cm 
Gerota fascia (thickness): 

• 1-2 mm 
Spleen: 

• Width: 7-10 cm 

• Depth: 4-6 cm 

• Length: 11-15 cm 
Diameter of abdominal aorta: 

• Approximately 18-30 mm 



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Adrenal Glands 63 




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64 CT: Abdomen 



Female Pelvis 

The pelvic inlet appears normal, with normal configuration of the iliac 
wings and iliopsoas muscles. 

Imaged bowel structures, especially the cecum and rectum, show no ab- 
normalities with no evidence of wall thickening or mass lesions. The 
perirectal fat and ischiorectal fossa are unremarkable. The uterus is or- 
thotopic with smooth borders. It displays a normal configuration and 
appropriate development for age. The myometrium shows homo- 
geneous density. The uterine cavity is normally developed, and the 
adnexa are unremarkable. The vaginal fornix is normal. 
The adequately distended urinary bladder has smooth outer contours 
and normal wall thickness. The vessels of the lesser pelvis are normal in 
course and caliber. There are no signs of lymphadenopathy. 
The appearance of the pelvic skeleton, especially the femoral heads, 
sacroiliac joints, and symphysis pubis, is normal. There are no signifi- 
cant soft-tissue abnormalities. 



Interpretation 

The lesser pelvis appears normal at CT. 



Checklist 

Pelvic inlet • Configuration 

• Width 

• Symmetry 

• Iliac wings (shape) 

• Iliopsoas muscles: 

— Size 

— Density 

— Symmetry 
Intestinal • Position 

structures • Wall thickness (when normally distended, see 

(especially the below) 

cecum and • No circumscribed wall thickening 

rectum) • Well-opacified lumen with no soft-tissue mass 

Perirectal fat • Density (fat attenuation) 

• No infiltration 

• No masses 
Ischiorectal fossa • Bilateral symmetry 

• No masses 



No lymphadenopathy 



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Female Pelvis 65 



Uterus 



Cervix, vagina 



Ovaries 



Urinary bladder 



Vessels 



Lymph node 
stations 
Pelvic skeleton 



Subcutaneous 
tissue and 
muscles 



Position 

Size 

Borders (smooth outer contours) 

Density (see below) 

Uterine cavity: 

— Configuration 

— Size 

— Density 

— Contents 
Position 
Size 
Borders 
Position 
Size 
Density 
Symmetry 

No masses of soft-tissue or fluid density 

Adequate distention 

Smooth outer contours 

Wall thickness (see below) 

Caliber 

Course 

No significant intimal calcifications 

No nodal enlargement (>1 cm) 

Configuration 

Margins (cortex smooth and sharp with no dis- 
continuities) 
Bony structures 

No circumscribed hypo- or hyperdense areas 
Femoral heads are rounded and centered in 
acetabula 

Sacroiliac joints are smooth and of normal width 
Symphysis pubis (see below) 
Density 
Extent 
Borders 
Symmetry 



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66 CT: Abdomen 



Important Data 

1 Sacroiliac joint spaces: 

• Cartilage thickness 2-5 mm (anterior and inferior: 2-3 mm) 

2 Uterus: 

• Size (variable): Prepubescent: length up to 3 cm, transverse 
diameter ca. 1 cm 

• Nullipara: length up to 8 cm, transverse diameter ca. 4 cm 

• Multipara: length up to 9.5 cm, transverse diameter ca. 
5.5 cm 

• Postmenopausal: length up to 6 cm, transverse diameter ca. 
2 cm 

a Transverse diameter of upright uterus (= well-distended 

bladder) < 5 cm 
b Uterine cervix: transverse diameter < 3 cm 




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Female Pelvis 67 



3 


Ovaries: 




• Prepubescence: a, length up to 2.5 cm; b, transverse diame- 




ter ca. 2.5 cm 




• Sexual maturity: a, length up to 4 cm; b, transverse diame- 




ter ca. 2.5 cm 




• Postmenopausal: a, length up to 3 cm; b, transverse diame- 




ter ca. 1.5 cm 


4 


Urinary bladder: 




• Wall thickness (of well-distended bladder): ca. 3 mm 


5 


Rectum: 




• Wall thickness < 5 mm 


6 


Symphysis pubis: 




• Width < 6 mm 


7 


Pelvic dimensions: 




• Pelvic outlet: anteroposterior (= coccyx to posterior edge of 




symphysis): ca. 9 cm 




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68 CT: Abdomen 



Male Pelvis 

The pelvic inlet appears normal, with normal configuration of the iliac 
wings and iliopsoas muscles. 

Imaged bowel structures, especially the cecum and rectum, show no ab- 
normalities with no evidence of wall thickening or mass lesions. The 
perirectal fat and ischiorectal fossa are unremarkable. The adequately 
distended urinary bladder has smooth outer contours and normal wall 
thickness. The seminal vesicles are of normal size. The angle between 
the bladder and seminal vesicle is clear and normal on each side. 
The prostate shows normal size and configuration and a homogeneous 
internal structure. 

The vessels of the lesser pelvis are normal in course and caliber. There 
are no signs of lymphadenopathy. 

The appearance of the pelvic skeleton, especially the femoral heads and 
sacroiliac joints, is normal. 
There are no soft-tissue abnormalities. 



Interpretation 

The lesser pelvis appears normal at CT. 



Checklist 

Pelvic inlet • Configuration 

• Width 

• Symmetry 

• Iliac wings (shape) 

• Iliopsoas muscles: 

— Size 

— Density 

— Symmetry 
Position 

Wall thickness (when normally distended, see 
below) 

No circumscribed wall thickening 
Well-opacified lumen with no soft-tissue mass 
Density (fat attenuation) 

• No infiltration 

• No masses 
Ischiorectal fossa • Bilateral symmetry 

• No masses 



Intestinal struc- 
tures (especially 
the cecum and 
rectum) 

Perirectal fat 



No lymphadenopathy 



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Male Pelvis 69 



Urinary bladder 



Seminal vesicles 



Prostate 



Vessels 



Lymph node 
stations 
Pelvic skeleton 



Subcutaneous 
tissue and 
muscles 



Adequate distention 
Smooth outer contours 
Wall thickness (see below) 
Position (behind the bladder) 
Size (see below) 
Symmetry 

Angle between bladder and seminal vesicle (see 
below) is clear on each side 
Position (central at bladder outlet) 
Configuration (rounded) 
Size (see below) 

Density (homogeneous, see below) 
No calcifications 

No unilateral nonhomogeneity after contrast ad- 
ministration 
Caliber 
Course 

No significant intimal calcifications 
No adenopathy 

Configuration 

Margins (cortex smooth and sharp, no discon- 
tinuities) 
Bony structures 

No circumscribed hypodense or hyperdense 
areas 

Femoral heads are rounded and centered in 
acetabula 

Sacroiliac joints are smooth and of normal width 
(see below) 
Symphysis pubis 
Density 
Extent 
Borders 
Symmetry 



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70 CT: Abdomen 



Important Data 

1 Sacroiliac joint spaces: 

• Width 2-5 mm (anterior and inferior: 2-3 mm) 

2 Urinary bladder: 

• Wall thickness (of well-distended bladder): ca. 3 mm 

3 Seminal vesicles: 

• Size (highly variable): 
a Length up to 5 cm 

b Width up to 2 cm, height up to 2.5 cm 
c Angle between bladder and seminal vesicle: clear on each 
side 

4 Prostate: 

• Size (varies with age, 20-70 years): 
a Anteroposterior diameter 2.5-3 cm 

b Lateral (and craniocaudal diameter) 3-5 cm 
Attenuation value: 40-65 HU 

5 Rectum: 

• Wall thickness < 5 mm 




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72 

CT: Spinal Column 

Cervical Spine 

The cervical spine shows a normal degree of lordosis in the lateral sur- 
vey scan, with no segmental malalignment. 

The vertebral bodies show normal configuration and trabecular struc- 
ture. The cortical margins are of normal thickness and are free of 
osteophytes. 

The bony spinal canal shows normal sagittal diameter. 
The intervertebral disks show normal CT density and normal posterior 
concavity. The disks do not project past the posterior surface of the 
vertebral bodies. The spinal cord is centrally placed and of normal 
width. It has homogeneous density and shows no circumscribed nar- 
rowing or expansion. 

The nerve roots show a normal course and passage through the neuro- 
foramina, which are of normal size and structure. The facet joints and 
uncovertebral joints are unremarkable. 
The prevertebral and paravertebral soft tissues show no abnormalities. 

Interpretation 

The examined segments of the cervical spine appear normal. 



Checklist 

Position • Cervical lordosis 

• No segmental malalignment (lateral survey 
scan) 

• Normal position of dens (see below) 
Bony spinal • Width (see below) 

canal • Shape 

Vertebral bodies • Shape 

• Cortex (thickness, margins: smooth, sharp) 

• No marginal osteophytes 

• Trabeculae (uniform honeycomb arrangement, 
no rarefaction or circumscribed voids, no nar- 
rowing or expansion) 



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Cervical Spine 73 



Intervertebral 
disk space 



Spinal cord 



Neuroforamina 



Nerve roots 
Facet joints 

Soft tissues 



Bony structure (if evaluable: no lytic defects, 
fracture lines, or osteoplastic areas) 
Width 

Margins (smooth, sharp) 
Straight posterior disk contour 
No disk protrusion past posterior surface of adja- 
cent vertebral bodies 
Position (central) 
Width (see below) 

No circumscribed narrowing or expansion 
Density (homogeneous) 
Perimedullary thecal space clear: 
— No encroachment from the anterior side (e.g., 
by an intervertebral disk or osteophyte) or 
posterior side (e.g., by a hypertrophic liga- 
mentum flavum) 
Configuration 
Width 

No encroachment from the anterior side (e.g., by 
an intervertebral disk, osteophyte, or uncoverte- 
bral arthrosis) or posterior side (e.g., by hyper- 
trophic spondylarthrosis) 
Course and passage through the neuroforamina 
No circumscribed expansion 
Shape, symmetry 
Pars interarticularis 
Vertebral arches intact 

Spinous processes (shape, length, bony struc- 
ture) 

Symmetrical arrangement on both sides of the 
vertebral bodies and spinous processes 
No masses 

Prevertebral soft-tissue structures (especially 
the pharynx and thyroid gland; no masses) 



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74 CT: Spinal Column 



Important Data 

1 Anteroposterior diameter of preodontoid space: 

• < 2 mm 

2 Sagittal diameter: 

• CI > 21 mm 

• C2 > 20 mm 

• C3 > 17 mm 

• C4-C7 = 14 mm 




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Cervical Spine 75 



3 Width of spinal canal: 

• Transverse diameter at level of pedicles > 20-21 mm 

4 Width of spinal cord: 

• > 6-7 mm in sagittal plane 




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76 CT: Spinal Column 



Thoracic Spine 

The thoracic spine shows a normal degree of kyphosis in the lateral sur- 
vey scan, with no segmental malalignment. 

The vertebral bodies show normal shape and trabecular structure. The 
cortical margins are of normal thickness and are free of osteophytes. 
The bony spinal canal has normal sagittal diameter. 
The intervertebral disks show normal CT density and normal posterior 
concavity. The disks do not project past the posterior surface of the 
vertebral bodies. The spinal cord is centrally placed and of normal 
width. It has homogeneous density and shows no circumscribed nar- 
rowing or expansion. 

The nerve roots show a normal course and passage through the neuro- 
foramina, which are of normal size and structure. The costovertebral 
and costotransverse joints are unremarkable. 
The prevertebral and paravertebral soft tissues show no abnormalities. 

Interpretation 

The examined segments of the thoracic spine appear normal. 



Checklist 
Position 



Bony spinal 
canal 
Vertebral bodies 



Intervertebral 
disk space 



Spinal cord 



Thoracic kyphosis 

No segmental malalignment (lateral survey 
scan) 

Width (see below) 
Shape 
Shape 

Cortex (thickness, margins: smooth, sharp) 
No marginal osteophytes 
Trabeculae (uniform honeycomb arrangement, 
no rarefaction or circumscribed voids, no nar- 
rowing or expansion) 
Width (see below) 
Margins (smooth, sharp) 
Straight posterior disk contour 
No disk protrusion past posterior surface of 
vertebral bodies 
Position (central) 
Width 

No circumscribed narrowing or expansion 
Density (homogeneous) 



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Thoracic Spine 77 



Neuroforamina 



Nerve roots 



Facet joints 



Soft tissues 



Perimedullary thecal space clear: no encroach- 
ment from the anterior side (e.g., by an inter- 
vertebral disk or osteophyte) or posterior side 
(e.g., by a hypertrophic ligamentum flavum) 
Configuration 
Width 

No encroachment from the anterior side (e.g., by 
an intervertebral disk or osteophyte) or posterior 
side (e.g., by hypertrophic spondylarthrosis) 
Course and passage through the neuroforamina 
No circumscribed expansion 
Shape, symmetry 
Pars interarticularis 
Vertebral arches intact 

Spinous processes (shape, length, bony struc- 
ture) 

Costotransverse joints 
Costovertebral joints (no hypertrophy) 
Ribs 

Symmetrical arrangement on both sides of the 
vertebral bodies and spinous processes 
No masses 

Prevertebral soft-tissue structures (especially 
the lungs, heart, and aorta) 



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78 CT: Spinal Column 



Important Data 

1 Width of spinal canal: 

• Transverse diameter at level of pedicles > 20-21 mm 

2 Sagittal diameter: 

• Tl-Tll = 13-14 mm, T12 = 15 mm 

3 Jones-Thomson ratio (= Ax B/CxD): 

• Between 0.5 and 0.22 = normal (< 0.22 = spinal stenosis) 

4 Width of intervertebral disk spaces: 

• Smallest at Tl 

• T6-T11: ca. 4-5 mm 

• Largest at Til -Tl 2 




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Thoracic Spine 79 




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80 CT: Spinal Column 



Lumbar Spine 

The lumbar spine shows normal lordotic curvature in the lateral survey 
scan, with no segmental malalignment. 

The vertebral bodies have normal shape and trabecular structure. The 
cortical margins are of normal thickness and are free of osteophytes. 
The bony spinal canal has a normal sagittal diameter. 
The intervertebral disks show normal density and normal posterior 
concavity. The disks do not project past the posterior surface of the 
vertebral bodies. 

The conus medullaris shows a normal position at LI with normal sub- 
division into filaments. The dural sac is of normal width. 
The nerve roots show a normal course and passage through the neuro- 
foramina, which are of normal size and structure. The facet joints are 
unremarkable. 
The prevertebral and paravertebral soft tissues show no abnormalities. 

Interpretation 

The examined segments of the lumbar spine appear normal. 



Checklist 
Position 



Bony spinal 
canal 
Vertebral bodies 



Intervertebral 
disk space 



Dural tube 



Lumbar lordosis 
Lumbosacral angle (see below) 
No segmental malalignment (lateral survey 
scan) 
Shape 

Width (see below) 
Shape 

Cortex (thickness, margins: smooth, sharp) 
No marginal osteophytes 
Trabeculae (uniform honeycomb arrangement, 
no rarefaction or circumscribed voids, no nar- 
rowing or expansion) 
Width (see below) 
Margins (smooth, sharp) 

No disk protrusion past posterior surface of 
vertebral bodies (posterior disk contour is con- 
cave at L1-L4, straight at L4/5, and slightly con- 
vex at L5/S1) 
Normal width 



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Lumbar Spine 81 



Neuroforamina 



No circumscribed narrowing or expansion 
Contents of fluid attenuation 
Conus medullaris (at LI level, configuration) 
Filaments show normal width and arrangement 
with no posterior adhesion and no circum- 
scribed anterior encroachment (e.g., by an inter- 
vertebral disk or osteophyte) or posterior en- 
croachment (e.g., by a hypertrophic ligamentum 
flavum) 
Configuration 
Width 

No anterior encroachment (e.g., by an interverte- 
bral disk, osteophyte, or uncovertebral arthrosis) 
or posterior encroachment (e.g., by hypertrophic 
spondylarthrosis) 

Course and passage through the neuroforamina 
No circumscribed expansion 
Shape, symmetry 
Pars interarticularis 
Vertebral arches intact 

Spinous processes (shape, length, bony struc- 
ture) 

Symmetrical arrangement on both sides of the 
vertebral bodies and spinous processes 
No masses 
Prevertebral soft-tissue structures (aorta, vena 



Nerve roots 



Facet joints 



Soft tissues 



cava), no masses 



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82 CT: Spinal Column 



Important Data 

1 Lumbosacral angle (SI /horizontal plane): 

• 26-57° 

2 Width of intervertebral disk space or height of lumbar in- 
tervertebral disks: 

• Approx. 8-12 mm, increasing from LI to L4/5, decreasing 
again at L5/S1 

3 Width of spinal canal: 

• Transverse diameter at level of pedicles: L1-L4 >20- 
21 mm, L5 > 24 mm 

4 Sagittal diameter: 

• 16-18 mm (simple formula: not less than 15 mm; 11- 
15 mm = relative stenosis, less than 10 mm = absolute ste- 
nosis) 

5 Jones-Thomson ratio (= Ax B/CxD): 

• Between 0.5 and 0.22 = normal (<0.22 = spinal stenosis) 

6 Lateral recess (sagittal diameter): 

• > 4-5 mm 

7 Ligamenta flava: 

• Width < 6 mm 

8 CT density of intervertebral disks: 

• 70 ± 5 HU 





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Lumbar Spine 83 




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Magnetic Resonance Imaging 



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87 

MRI: Head and Neck 



Neurocranium 

The interhemispheric fissure is centered on the midline. The cerebrum 
and cerebellum exhibit normal cortical sulcation. 
The cerebral ventricles are of normal size and symmetrical with normal 
circulation of CSF. There are no signs of increased intracranial pressure. 
The cortex and white matter show normal development and normal 
signal intensity, especially in the periventricular white matter. 
No abnormalities are seen in the basal ganglia, internal capsule, corpus 
callosum, or thalamus. 

The brain stem and cerebellum show no abnormal changes in signal 
characteristics. 

The sella and pituitary are normal, and parasellar structures are unre- 
markable. 

The cerebellopontine angle area appears normal on each side. The inter- 
nal acoustic meatus has normal width. 

The paranasal sinuses and mastoid air cells show normal development 
and pneumatization. The orbital contents are unremarkable. 

Interpretation 

Cranial MRI is normal. 



Checklist 

Interhemispheric • Centered on the midline 
fissure • No displacement 

• Falx cerebri: 

— Width 

— Signal characteristics 

— Flow in the dural sinuses (if the sequence per- 
mits flow assessment) 

Cortical sulcation • Configuration 

in the cerebrum • Number of sulci 

and cerebellum • Width of sulci 

(arbor vitae) • No coarsening of sulci 



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88 MRI: Head and Neck 



Cerebral cortex 



Ventricles 



White matter 



Basal ganglia, 
internal and 
external capsule, 
thalamus 
Corpus callosum 



Brain stem 



No circumscribed widening or narrowing 
Cisterns and cortical markings are well defined 
Width 

Distribution (no ectopic tissue) 
Signal characteristics (no hyperintense [demy- 
elination, edema, hemorrhage] or hypointense 
[calcification, hemorrhage] changes) 
No areas of separation from the calvarium 
No abnormal fluid collection (convex or con- 
cave) between the cerebral cortex and calvar- 
ium 
Shape 

Size normal for age (see below) 
Symmetry (no unilateral or circumscribed en- 
largement) 

Evidence of flow in the (centrally located) aque- 
duct 

Fourth ventricle is tent-shaped and not dilated 
No signs of increased intracranial pressure 
(e.g., effaced sulci, narrowed or widened ven- 
tricles) 

Signal characteristics (maturity appropriate for 
age; homogeneous signal intensity, especially at 
periventricular sites; no patchy or circumscribed 
hyperintense [demyelination, edema, hemor- 
rhage] or hypointense [calcification, hemor- 
rhage] signal changes) 
Normal width in relation to cortex 
Position 
Size 

Delineation 
Signal intensity 
Anatomy 
Configuration 
Size 

No circumscribed narrowing or expansion 
No foci of demyelination 
No masses 
Shape 

Signal intensity (homogeneous) 
No focal abnormalities 

Cranial nerves (presence, course, width, sym- 
metry) 



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Neurocranium 89 



Cerebellum 



Intracranial 
vessels 



Sella and 
pituitary 



Petrous pyramids • 



Paranasal sinuses • 



Anatomy (symmetry) 
Cortex (width, sulcation) 
White matter (homogeneous signal intensity) 
Course 
Width 

No abnormal dilatation 
No vascular malformations 
Size (see below) 

Configuration (surface flat or slightly concave, 
infundibulum centered) 

Signal intensity (neurohypophysis and adeno- 
hypophysis, no circumscribed change in signal 
intensity before or after contrast administra- 
tion) 

Parasellar structures (optic chiasm, suprasellar 
CSF spaces, carotid siphon, cavernous sinus) are 
unremarkable 
Cerebellopontine angle area: 

— Width of internal auditory canals (see 
below) 

— CSF spaces (symmetrical, fluid intensity) 

— No masses 

— Vestibulocochlear nerve clearly defined 
Mastoid cells, mastoid antrum 

— Anatomy 

— Pneumatization 

— Borders (wall thickness, smooth and continu- 
ous contours) 

— No masses 

— Not fluid-filled 

Cochlea and semicircular canals: 

— Anatomy 

— Configuration 

— Smooth borders 
Anatomy 
Pneumatization 

Borders (wall thickness, smooth and continuous 

contours) 

Nasal cavity: 

— Pneumatization 

— Septum on midline 

— Turbinates (presence of superior, middle, and 
inferior turbinates; width) 



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90 MRI: Head and Neck 



Orbit • Configuration of orbital cone 

• Contents: 

— Globe (position, size, signal intensity, wall 
thickness) 

— Eye muscles (position, course, signal inten- 
sity, width) 

— Optic nerve (course, width— see below) 

— Ophthalmic vein (course, width— see below) 



Important Data 

Vetricular dimensions: 

1 Cella media index: 

• B/A>4 = normal 

2 Frontal horn of lateral ventricle (at level of foramen of 
Monro): 

• Under 40 years: < 12 mm 

• Over 40 years: < 15 mm 

3 Width of third ventricle: 

• < 5 mm in children (slightly more in infants) 

• < 7 mm in adults under age 60 

• < 9 mm in adults over age 60 



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Neurocranium 91 




Axial image 




Axial image 



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92 MRI: Head and Neck 



4 


Width of ophthalmic vein: 




• 3-4 mm 


5 


Optic nerve (axial image): 




a Retrobulbar segment: 5.5 mm ± 0.8 mm 




b Narrowest point (at approximately mid-orbit): 4.2 mm ± 




0.6 mm 




Axial image 



Axial image 



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Neurocranium 93 



6 Position of globe: 

• Posterior margin of globe 9.9 mm ± 1.7 mm behind interzy- 
gomatic line 

7 Internal auditory canal: 

• Approximately 5-10 mm, with no more than 1 mm differ- 
ence between the right and left sides 




Axial image 



Coronal image 



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94 MRI: Head and Neck 



Pituitary: 

• Height of pituitary in sagittal plane: 2-6 mm 
Caution: normal size variations during 

— Pregnancy: up to 12 mm 

— Puberty: up to 10 mm in girls, up to 8 mm in boys 




Sagittal image 



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Pituitary 95 

Pituitary 

The size, position, and configuration of the sella are normal. The floor 
and walls of the sella are smooth and well-defined. 
The pituitary is normal in size, shape, and position. The pituitary tissue 
shows normal signal characteristics both before and after contrast in- 
jection, with no circumscribed abnormalities of signal intensity. 
The infundibulum is centered and of normal size. 
The optic chiasm and suprasellar CSF spaces appear normal. 
The cavernous sinus and imaged portions of the internal carotid artery 
and carotid siphon are unremarkable. 

Evaluable portions of the neurocranium show no abnormalities. 
The sphenoid sinus is clear and pneumatized. 

Interpretation 

The pituitary appears normal. 



Checklist 
Sella 



Pituitary 



Position 
Size 

Configuration (U-shaped) 
Walls steep, not splayed 
Borders smooth, sharp, and of normal width 
Position (centered in the sella) 
Configuration (bean-shaped) 
Superior border straight or slightly concave 
(convex only during puberty or pregnancy) 
Size (see below) 

Delineation of adenohypophysis and neurohy- 
pophysis (sagittal image) 
Pituitary tissue homogeneous on noncontrast 
images 

Homogeneous contrast enhancement 
No circumscribed hypointense or hyperintense 
areas (especially on coronal images, no signal 
difference between left and right halves of pitui- 
tary) 

Dynamic sequence (if performed) shows no time 
differential in the enhancement of different 
pituitary areas 



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96 MRI: Head and Neck 



Infundibulum 
Optic chiasm 



Suprasellar CSF 
spaces (chias- 
matic cistern) 
Cavernous 
sinuses 

Internal carotid 
arteries 



Neurocranium 



Sphenoid sinus 



Position (centered) 

Size (see below) 

Position 

Size (see below) 

Symmetry 

Symmetrical 

Not constricted 

Symmetry 

Size 

No infiltration 

Symmetry 

Size (especially in siphon area) 

No circumscribed or generalized narrowing or 

expansion 

Temporal lobe 

Hypothalamus 

Floor of third ventricle 

Smooth margins, normal width (especially of the 

roof), clear and pneumatized 



Important Data 

Pituitary 

1 Sagittal diameter: 

• Men and postmenopausal women: < 8 mm 

• Women of childbearing age: < 10 mm 

2 Height in sagittal plane: 

• 2-6 mm {Caution: normal size variations during 

— Pregnancy: up to 12 mm 

— Puberty: up to 10 mm in girls, up to 8 mm in boys 

3 Pituitary stalk: 

• < 4 mm 



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Pituitary 97 




Sagittal image 




Coronal image 



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98 MRI: Head and Neck 



4 Optic chiasm: 

• Coronal: a, width 9-18 mm; b, height 3-6 mm 

• Axial: c, width 12-27 mm; d, depth 4-9 mm 




Coronal image 



Axial image 



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Pituitary 99 



Axial image 





Coronal image: dynamic 
examination following 
intravenous contrast 
administration (Cd-DTPA: 
gadolinium diethylene- 
triamine pentaacetic acid) 



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100 MRI: Head and Neck 



Internal Auditory Canals, Petrous Pyramids 

The petrous pyramids appear normal and symmetrical. The internal 
acoustic meatus is of normal width, and its walls are smooth and 
sharply defined. The vestibulocochlear nerve on each side shows nor- 
mal course and diameter. Contrast administration is not followed by ab- 
normal rise of signal intensity within the nerve, especially its in- 
trameatal portion. 

The cochlea and semicircular canals appear normal. The mastoid air 
cells are clear and pneumatized. The tympanic cavity and external audi- 
tory canal are normal. 

The cerebellopontine angle area shows normal configuration on each 
side. 

The brain stem shows normal configuration and normal signal charac- 
teristics, with normal emergence of the nerves of the auditory canal. 
The cerebellopontine angle cistern is clear and symmetrical on each 
side. 
The other imaged portions of the neurocranium are unremarkable. 

Interpretation 

The internal auditory canals appear normal. 



Checklist 

Petrous pyramids • Configuration 

• Bilateral symmetry 

• Internal auditory canals: 

— Shape 

— Course 

— Width (see below) 

— Borders (smooth, sharp) 
Course (straight, continuous) 
Width (uniform, no right-left discrepancy, no 
circumscribed expansion) 
Enhancement characteristics (nonenhancing, 
especially within the meatus) 
Course (starts parallel to vestibulocochlear 
nerve) 

Width (uniform, no right-left discrepancy, no 
circumscribed expansion) 
Enhancement characteristics (nonenhancing) 



Vestibulocochlear • 
nerve (cranial • 
nerve VIII) 



Facial nerve 
(cranial nerve VII) 



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Internal Auditory Canals, Petrous Pyramids 101 



Cochlea and 
semicircular 
canals 

Mastoid cells, 
mastoid antrum, 
tympanic cavity 



External auditory 
canal 



Cerebellopontine 
angle area 



Rest of neuro- 
cranium 



Anatomy 

Configuration 

Smooth borders 

Anatomy 

Pneumatization 

Borders (wall thickness, smooth and continuous 

contours) 

No masses 

Not opacified by material of soft-tissue or fluid 

signal intensity 

Anatomy 

Course 

Width 

Borders 

Brain stem: 

— Shape 

— Signal intensity (homogeneous) 

— No focal abnormalities 
Vestibulocochlear and facial nuclei (motor root 
in medial eminence on floor of fourth ven- 
tricle): 

— No demyelination 

— No masses 

Sites of entry of vestibulocochlear nerve (enters 
pons and medulla at lateral extension of medul- 
lopontine sulcus) and facial nerve: 

— Bilaterally symmetrical 
CSF spaces: 

— Cerebellopontine angle cistern (symmetrical, 
fluid intensity) 

— No masses 

— Well delineated 

— No vascular loops 

Cerebrum (especially the temporal lobe) and 
cerebellum: 

— Configuration 

— Sulcation 

— Cortical markings (arbor vitae) not effaced 

— Width of sulci 

— No circumscribed narrowing or expansion 

— Homogeneous signal intensity of cortex and 
white matter (no hypointense or hyper- 
intense changes) 



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102 



CSF spaces 



Prepontine cistern 
Fourth ventricle 



Important Data 

1 Internal auditory canal: 

• Approximately 5-10 mm 

2 Difference between right and left internal auditory canals: 

• Approximately 1 mm 




Axial image 



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Internal Auditory Canals, Petrous Pyramids 103 




Axial image 




Coronal image 



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104 MRI: Head and Neck 



Orbit 

The orbits are symmetrical and of normal size, with normal develop- 
ment of the orbital cones. The orbital walls show a normal configuration 
with smooth, sharp margins. No foci of bone destruction, no circum- 
scribed expansion of the bony or soft-tissue components of the orbital 
wall are evident. 

The globes are symmetrical and of normal size and position, and the 
ocular contents show normal signal characteristics. The ocular walls are 
smooth, sharply defined, and of normal thickness. The optic nerve has 
normal course and caliber on each side. 

The eye muscles are normally positioned and display normal course and 
width. The retrobulbar fat, ophthalmic vein, and lacrimal gland are un- 
remarkable. 

Evaluable portions of the neurocranium and paranasal sinuses show no 
abnormalities. 



Interpretation 

The orbits and orbital contents appear normal. 



Checklist 
Orbits 



Globe 



Shape (orbital cone) 
Size 

Symmetry 
Orbital walls: 

— Borders (smooth and sharp) 

— No bone destruction 

— No circumscribed expansion of bony or soft- 
tissue components of the orbital wall 

Shape (spherical) 
Size (see below) 
Position (see below) 
Symmetry 
Ocular contents: 

— Signal intensity (fluid-equivalent) 
Ocular wall: 

— Borders (smooth and sharp) 

— Thickness 
Retrobulbar fat (clear) 
No masses 



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Orbit 105 



Optic nerve 
Eye muscles 

Ophthalmic vein 
Lacrimal gland 



Neurocranium 
Paranasal sinuses 



Caliber (see below) 

Course 

Position 

Width (see below) 

Course 

Course 

Caliber (see below) 

Size 

Symmetry 

No unilateral or bilateral enlargement 

Position (see below) 

No excavation or destruction of adjacent bone 

Homogeneous internal structure 

No hypointense or hyperintense changes 

Smooth borders 

Temporal lobes 

Frontal lobes 

Maxillary sinuses 

Ethmoid cells 




Axial image through center of orbits 



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106 MRI: Head and Neck 



Important Data 




1 Diameter of globe: 




a Axial image plane 


right 28.6 ± 1.2 mm 




left 29.4 ± 1.4 mm 


b Sagittal image plane: right 27.8 ± 1.2 mm 




left 28.2 ± 1.2 mm 




Axial image through roof of orbit 



-5a 




-4c 
-4d 

-4e 



Coronal image 



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Orbit 107 



Position of globe: 

• Posterior margin of globe is 9.9 mm ± 1.7 mm behind in- 
terzygomatic line 

Optic nerve (axial image plane): 

a Retrobulbar segment: 5.5 mm ± 0.8 mm 

b Narrowest point (at approximately mid-orbit): 4.2 mm ± 

0.6 mm 
Eye muscles: 

a Lateral rectus: 2.9 mm ± 0.6 mm 
b Medial rectus: 4.1 mm ± 0.5 mm 
c Superior rectus: 3.8 mm ± 0.7 mm 
d Oblique: 2.4 mm ± 0.4 mm 
e Inferior rectus: 4.9 mm ± 0.8 mm 
f Levator palpebrae superioris: 1.75 mm ± 0.25 mm 
Ophthalmic vein: 

a 1.8 mm ± 0.5 mm (axial image, 4 mm slice thickness) 
b 2.7 mm ± 1 mm (coronal image) 
Lacrimal gland: 

• Less than one-half of the gland is anterior to the frontozygo- 
matic process 




Sagittal image 



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108 MRI: Head and Neck 



Paranasal Sinuses 

The frontal sinuses are normally developed, clear, and pneumatized 
with smooth wall contours. 

The ethmoid cells show normal development and intact bony walls, 
with no defects on the orbital side. There are no areas of wall erosion or 
mucosal thickening. 

The sphenoid sinus is normally developed and presents a coarse honey- 
comb structure. There are no fluid collections or mucosal swelling. 
The maxillary sinuses are bilaterally symmetrical and have smooth 
walls of normal thickness. The sinuses are clear and aerated with no foci 
of bone erosion or destruction. The nasal septum is centered on the 
midline. The nasal turbinates show a normal arrangement and normal 
signal intensity. 

The nasal cavity, pharynx, and imaged parapharyngeal structures show 
no abnormalities. 



Interpretation 

The paranasal sinuses appear normal. 



Checklist 
Frontal sinuses 



Ethmoid cells 



Sphenoid sinus 



Maxillary sinuses 



Anatomy 

Wall contours (smooth) 
Pneumatization 
Anatomy 
Pneumatization 

Bony structures (especially bordering the orbit: 
contours are smooth, sharp, and intact) 
No wall erosion 
No mucosal thickening 
Anatomy (coarse honeycomb structure) 
Clear and pneumatized 
No fluid collection 
No mucosal swelling 

Bony structures (smooth, intact walls, no ero- 
sion) 

No extrinsic wall indentations 
Anatomy 

Size (bilaterally symmetrical) 
Bony structures (smooth, intact contours, normal 
wall thickness, no bone erosion or destruction) 



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Paranasal Sinuses 109 



Nasal cavity 



Pharynx and 

parapharyngeal 

structures 



Neurocranium 
(especially the 
temporal and 
frontal lobes) 
Orbit 



Pneumatization 

No tooth roots projecting through sinus floor 

Anatomy (symmetry) 

Size 

Aeration (clear) 

Septum centered on the midline 

Nasal turbinates (three per side: superior, 

middle, inferior) are normally developed 

Signal characteristics 

Anatomy (symmetry) 

Size 

Wall thickness 

No foreign bodies 

No masses 

Cortex 

White matter 

Gyration 

Signal characteristics 

Eye muscles (width, signal characteristics) 

Optic nerve (width, course) 

Globe (shape, size, signal characteristics) 

Retrobulbar fat (no masses) 




Coronal image 



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110 MRI: Head and Neck 



Important Data 

1 Frontal sinus: 

• Height ca. 1.5-2 cm 

2 Sphenoid sinus: 

• Width 0.9-1.4 cm 

3 Maxillary sinuses; 

a Width ca. 2 cm 
b Height ca. 2 cm 



Coronal image 




Axial image 



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Paranasal Sinuses 111 





Sagittal image 



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112 MRI: Head and Neck 



Cervical Soft Tissues 

The cervical soft tissues show normal configuration. The position of the 
cervical spine is normal. 

The oral floor muscles are normally developed and bilaterally sym- 
metrical. The spaces of the oral cavity and neck are clear and well de- 
fined. 

Imaged portions of the parotid and submandibular glands show no ab- 
normalities. 

The pharynx and larynx show normal boundaries and normal wall 
thickness. 

The thyroid gland shows reasonable symmetry and normal size. The 
thyroid lobes display normal internal structure. 
Cervical vessels that are evaluable with MRI have normal appearance. 
The muscular structures of the neck are normal. 
There are no signs of cervical lymphadenopathy. 
No abnormalities are seen in the cervical spinal cord or cervical plexus. 



Interpretation 

The cervical soft tissues appear normal. 




Retropharyn 
geal space 

Posterior 
cervical space 

Perivertebral 
space 
(paraspina 
portion) 



Spaces of the neck 



Visceral space 

Anterior cer- 
vical space 
Carotid space 

Perivertebral 
space (pre- 
vertebral 
portion) 

Superficial 
space 



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Checklist 



Cervical Soft Tissues 113 



Cervical soft 
tissues 

Oral floor 
muscles 



Submandibular 
and parotid 
glands 



Pharynx and 
larynx 



Cervical spaces 



Esophagus 



Thyroid gland 



Configuration 

Normal anatomy 

Normal position of the cervical spine (see below) 

Anatomy 

Width 

Bilateral symmetry 

Delineation 

Internal structure 

Spaces of oral floor are clearly defined 

Size (symmetry) 

Signal characteristics 

No dilatation of glandular duct 

No hypointense or hyperintense areas within the 

glandular tissue 

Shape (symmetrical) 

Size 

Smooth walls 

Normal wall thickness 

No masses 

Retropharyngeal space 

Parapharyngeal space (visceral space) 

Carotid space 

Anterior and posterior cervical spaces 

Perivertebral space (prevertebral and paraspinal 

portions): 

— Configuration 

— Borders 

— Symmetry 

— Internal structure 

— Width (see below) 
Position 

Wall thickness (see below) 
Borders 
No masses 

Anatomy (consists of two lobes, reasonably sym- 
metrical) 
Size (see below) 

Internal structure (homogeneous) 
No cysts 
No nodules 



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114 MRI: Head and Neck 



Cervical vessels 



Neck muscles 



Lymph node 
stations (if 
evaluable) 
Cervical spine 
(if evaluable) 



Course 

Caliber (see below) 

No abrupt caliber changes 

Anatomy 

Symmetry 

Borders 

Signal characteristics (internal structure) 

No lymphadenopathy 



1 Vertebral bodies 

— Number 

— Shape 

— Position 

— Contours 

• Bone marrow signal 

• Intervertebral disk spaces 

• Spinal canal: 

— Width 

— No circumscribed narrowing 

• Normal width of cervical spinal cord 

• No masses 

• No narrowing 
Cervical plexus • No appreciable narrowing 

• No masses (including lymphadenopathy) 



Important Data 

Ch = Chamberlain's line (line connecting the posterior part of the 
hard palate with the posterior rim of the foramen magnum): 

• Tip of the dens projects no more than 1 ± 6.6 mm past 
Chamberlain's line 

Prevertebral soft tissues: 

1 Retropharyngeal: 

• Approximately 1.7 ± 0.7 mm 

2 Retroglottic: 

• Approximately 6.0 ± 1.1 mm 

3 Retrotracheal: 

• Approximatley 8.4 ± 2.5 mm 



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Cervical Soft Tissues 115 




Midsagittal image 




Sagittal image 



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116 MRI: Head and Neck 



Lumina of upper respiratory tract (normal respiration): 

4 Laryngeal inlet (hyoid level): 

• Approximatley 19 ± 4 mm 

5 Glottis: 

• Approximately 21 ± 4 mm 

6 Trachea: 

• Approximately 17 ± 3 mm 

7 Dimensions of thyroid gland: 
a Length: 3.5-6 cm 

b Width: 1.5-2 cm 
c Depth: 1-2 cm 
Vascular calibers (at level of thyroid gland): 

8 Common carotid artery: 

• 6-10 mm 

9 Esophagus: 

• Wall thickness 3 mm 




Axial image 



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Cervical Soft Tissues 117 




Coronal image 



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118 



MRI: Chest 



Thoracic Organs 

Both lungs are normally aerated and are applied to the chest wall on all 
sides. The pleurae show normal homogeneous signal intensity, and 
there are no fluid collections. 

The pulmonary structure is normal and presents normal vascular mark- 
ings. There are no intrapulmonary nodules or patchy densities. 
The mediastinum is centered and of normal width. There is no evidence 
of masses in the anterior, central, or posterior compartment. 
The hilar region on each side is unremarkable, and the main bronchi ap- 
pear normal. There is no lymphadenopathy and there are no perihilar 
masses. 

The heart is orthotopic and has a normal configuration. The cardiac 
chambers are of normal size. 

Major intrathoracic vessels are unremarkable, and imaged portions of 
the supra-aortic vessels appear normal. 
The thoracic skeleton and thoracic soft tissues show no abnormalities. 



Interpretation 

The thoracic organs appear normal. 



Checklist 
Lungs 



Mediastinum 



Anatomy (paired and symmetrical) 
Fully apposed to the chest wall 
No pleural thickening 

No fluid collection (patchy or circumscribed) 
Normal aeration 

Normal low signal of the lung parenchyma 
Normal pulmonary structure 
Vascular markings diminish from center to pe- 
riphery 

No pulmonary nodules 

No larger densities (e.g., plaques or infiltrates) 
Configuration 
Position: 



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Thoracic Organs 119 



Vessels 



Diaphragm 



Thoracic skeleton • 
(ribs, clavicle, • 
sternum, scapula) • 



Thoracic soft 
tissues 



— Centered 

— Width (see below) 

— No masses in the anterior, central, or poste- 
rior compartment 

Hilar region: 

— No masses 

— No lymphadenopathy 
Main bronchi: 

— Anatomy 

— Course 

— Width (see below) 
Heart: 

— Position (centered slightly left of midline) 

— Configuration 

— Size of cardiac chambers (see below) 

— Normal myocardial thickness (see below) 
Intrathoracic vessels (ascending aorta, aortic 
arch, descending aorta, vena cava): 

— Anatomy 

— Size 

Supra-aortic vessels (subclavian artery, brachio- 
cephalic trunk, left common carotid artery): 

— Anatomy 

— Size 

Shape (bell-shaped, no contour abnormalities, 

costophrenic angle is sharp and clear) 

Position (at approximately the level of the 10th- 

11th posterior rib) 

Width (no circumscribed widening, no defect) 

Position 

Structure and signal characteristics 

Contours and symmetry 

No bony expansion or destruction 

Thoracic spine: 

— Position and shape of thoracic vertebrae 

— Spinal cord 

— Signal characteristics of thoracic vertebrae 
Normal 

Symmetrical 



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120 MRI: Chest 



Important Data 

1 Angle of tracheal bifurcation: 

• Approximately 55-65° 

2 Diameter of main bronchi: 

a Right approx. 15 mm 
b Left approx. 13 mm 

3 Diameter of aorta: 

• <4 cm 
a Ascending aorta: 

a-. At level of pulmonary trunk bifurcation: 3.2 cm ± 0.5 cm 
a 2 At level of aortic root: 3.7 cm ± 0.3 cm 

b Aortic arch: 1.5 cm ± 1.2 cm 

c Descending aorta: 2.5 cm ± 0.4 cm 
Ratio of ascending to descending aortic diameters = 1.5:1 

4 Diameter of superior vena cava: 
a At level of aortic arch: 1.4 cm ± 0.4 cm 
b At level of pulmonary trunk bifurcation: 2 cm ± 0.4 cm 

5 Diameter of pulmonary arteries: 
a Pulmonary trunk: 2.4 cm ± 0.2 cm 
b Proximal right pulmonary artery: 1.9 cm ± 0.3 cm 
c Left pulmonary artery: 2.1 cm ± 0.4 cm 

6 Mediastinum: 

• Thymus 1-2 cm in transverse diameter 

Heart: 

Dimensions of cardiac chambers: 

7 Right atrium: 

• Maximum transverse diameter: 4.4 cm 
a At level of aortic root: 1.9 cm ± 0.8 cm 
b At level of mitral valve: 3.2 cm ± 1.2 cm 
c At center of ventricles: 2.8 cm ± 0.4 cm 

8 Left atrium: 
a Maximum anteroposterior diameter: 4-5 cm 

a, At level of aortic root: 2.4 cm ± 4.5 cm 
a 2 At level of mitral valve: 2.9 cm ± 4.9 cm 
b Maximum transverse diameter: 9 cm 
b 5 At level of aortic root: 5.5 cm ± 8.4 cm 
b 2 At level of mitral valve: 4.9 cm ± 9.1 cm 

9 Angle between midsagittal plane and septum = 38° (in- 
creases in response to pressure loading or volume loading of 
the ventricles) 

10 Thickness of ventricular septum: 
• Approximately 5-10 mm 

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Thoracic Organs 121 




Coronal image 




Coronal image 



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122 MRI: Chest 



Sagittal image 




Axial image at level of aortic arch 

11 Thickness of pericardium: 

• 1-2 mm 

12 Thickness of myocardium: 

• 10-12 mm 



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Thoracic Organs 123 




Axial image at level of pulmonary trunk bifurcation 



7a- 




-3a, 



-8b, 



8a, 



Axial image at level of aortic root 



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124 MRI: Chest 




Axial image at level of mitral valve 




Axial image through center of ventricles 



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Breast 1 25 



Breast 

The anatomy of the glandular breast tissue is symmetrical and normal 
for age. The breast parenchyma is uniformly subdivided by fatty tissue. 
Unenhanced MR images show no lesions that are hypointense or hyper- 
intense to the breast parenchyma or fat. 

Following contrast administration, a significant, abnormal rise in signal 
intensity is not observed in any segment of the breast. 
The skin and subcutaneous tissues show no abnormalities. 



Interpretation 

The breasts appear normal. 



Checklist 

Breast paren- 
chyma 



Noncontrast 
images 

Postcontrast 
images 



Skin and subcu- 
taneous tissues 

Axilla (unless 
obscured by 
motion artifacts) 



Size 

Symmetry 

Extent of breast parenchyma in relation to fat 
(note physiological involution of the paren- 
chyma with aging) 

Symmetrical development of glandular breast 
tissue 

Uniform subdivision by fat 
No lesions that are hypointense or hyperintense 
to the breast parenchyma or fat (cysts, solid 
tumors, stellate densities) 
No significant abnormal enhancement (more 
than about 70% of initial signal intensity in the 
early phase after contrast administration) 
No abnormal enhancing structures on delayed 
images 

Early, intense enhancement of the nipple area 
(confirms proper injection technique) 
Thickness 
No retraction 

No circumscribed expansion 
No lymphadenopathy 



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126 MRI: Chest 



Lungs (unless 
obscured by 
motion artifacts) 



Heart (unless 
obscured by 
motion artifacts) 



Complete aeration 
No pulmonary nodules 

Bony structures (ribs and sternum, unless ob- 
scured by motion artifacts): 

— Contours 

— Shape 

— No voids or expansion 

— Retrosternal structures (lymph nodes along 
internal thoracic artery) appear grossly nor- 
mal 

Shape 

Size 

Position 

Enhancement characteristics 




Axial image through the center of the breasts following contrast administration (Gd- 
DTPA: gadolinium diethylenetriaminepentaacetate) 



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Breast 1 27 




Subtraction image of the breasts 




3-D MIP (Maximum Intensity Projection) rendering of subtraction images 



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128 

MRI: Abdomen 



Upper Abdominal Organs 

The liver is normally positioned and has normal size and smooth 
borders. Its internal structure is normal, with no focal abnormalities of 
signal intensity. The intrahepatic and extrahepatic bile ducts are not 
distended. The porta hepatis appears normal. 

The gallbladder displays a normal size, smooth borders, and homo- 
geneous contents. 

The spleen is orthotopic and of normal size. It has smooth outer con- 
tours and a homogeneous internal structure. 

The pancreas is normal in size and position. The head, body, and tail of 
the organ have smooth, lobulated outer contours and normal internal 
structure. The pancreatic duct is unobstructed. 

Both kidneys are normal in size and position. The renal parenchyma 
shows normal width and structure. 

The renal pelvis and calices are normal. The urinary drainage tract is un- 
obstructed. 

Both adrenal glands are normal in position and size, and the adrenal 
crura are normally developed. The adrenal compartment is unremark- 
able. 

Major vessels and the para-aortic region appear normal, with no evi- 
dence of lymphadenopathy. 
Imaged portions of the lung and soft tissues show no abnormalities. 

Interpretation 

The upper abdominal organs appear normal. 



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Upper Abdomial Organs 129 



Checklist 
Liver 



Spleen 



Pancreas 



Position 

— Directly below the right hemidiaphragm 
Size (see below) 

Borders: 

— Smooth 

— Sharp 

No focal abnormalities 
Intrahepatic bile ducts: 

— Course (toward porta hepatis) 

— Width 

— No calculi 

— No air 
Extrahepatic bile ducts: 

— Course (from porta hepatis to head of pan- 
creas) 

— Width (see below) 

— Homogeneous contents of fluid-equivalent 
signal intensity 

— No calculi 

— No air 
Gallbladder: 

— Size (see below) 

— Contours (smooth) 

— Wall thickness (see below) 

— No pericholecystic fluid 
Gallbladder contents: 

— Homogeneous 

— Fluid-equivalent signal intensity 

— No calculi (hypointense or hyperintense) 

— No air 

Porta hepatis occupied by the hepatic artery, 

common bile duct, and portal vein 

No masses 

No lymphadenopathy 

Size (see below) 

Smooth outer contours 

Homogeneous internal structure 

Size normal for age (see below) 

Normal lobulation 

Smooth outer contours 



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130 MRI: Abdomen 



Kidneys 



Ureters 



Adrenal glands 



Intestinal 
structures 



Lungs 

Costophrenic 
sinus 
Soft tissues 



Pancreatic duct unobstructed (see below) 
No peripancreatic fluid 
Paired 

Position (see below) 
Size (see below) 
Smooth contours 
Width of cortex and medulla 
Renal pelvis (presence, symmetry, size, no 
widening, homogeneous fluid contents) 
Calices (shape, width, homogeneous contents) 
Enhancement characteristics (see below) 
Not duplicated 
Course 

No obstruction of urinary drainage 
Shape 

Size (see below) 

Slender crura (no asymmetric widening) 
No circumscribed hypointense (Tl: cyst, ade- 
noma), isointense, or hyperintense expansion 
Colon haustrations 
Small bowel 
Wall thickness 

Homogeneous opacification with oral contrast 
medium (if administered) 
No free extraintestinal or intra-abdominal air or 
fluid 
Para-aortic region: 

— Major vessels (position, size, fluid signal) 

— Soft tissues (no masses) 

— No lymphadenopathy 
Clear and expanded 

Clear and aerated on both sides 



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Upper Abdomial Organs 131 



Important Data 

Dimensions 

1 Liver: 

a Left lobe (anteroposterior diameter on the left paravertebral 
line): up to 5 cm 

b Caudate lobe/right lobe (CL/RL) = 0.37 ± 0.16 (e.g., 0.88 ± 0.2 
in cirrhosis). Reference lines [from medial side]: line I is tan- 
gent to the medial border of the caudate lobe; line II is paral- 
lel to I and tangent to the lateral aspect of the portal vein; 
line III is tangent to the lateral hepatic border and perpen- 
dicular to a line midway between the portal vein and infe- 
rior vena cava and perpendicular to I and II. 

c Angle of hepatic border: ca. 45° on the left side (formed by 
left lateral and inferior hepatic borders) 

2 Gallbladder: 

a Horizontal diameter up to 5 cm (> 5 cm is suspicious for hy- 
drops) 
b Width of gallbladder wall: 1-3 mm 

3 Width of common bile duct: 

• < 8 mm (< 10 mm after cholecystectomy) 

4 Spleen: 

a Depth: 4-6 cm 

b Width: 7-10 cm 

c Length: 11-15 cm 

Splenic index: DxWxL = 160-440 




Axial image 



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132 MRI: Abdomen 



5 Pancreas: 

a Head: up to 3.5 cm 
b Body: up to 2.5 cm 
c Tail: up to 2.5 cm 
Pancreatic duct: width 1-3 mm 

6 Adrenal glands (variable): 

• Crural thickness < 10 mm 

7 Kidneys: 

a Craniocaudal diameter: 8-13 cm 

b Anteroposterior diameter: ca. 4 cm 

c Transverse diameter 5-6 cm 

Position of superior poles of kidneys: 

d Right: superior border of LI 

d Left: inferior border of T12 

f Transverse renal axis: posteriorly divergent angle of 120° 

g Width of renal cortex: 4-5 mm 

Time to corticomedullary equilibrium: 1 minute 

Contrast excretion into the pyelocaliceal system: 3 minutes 

Gerota fascia (thickness): 1-2 mm 

Width of ureter: 4-7 mm 

8 Diameter of abdominal aorta: 

• Approximately 18-30 mm 

9 Inferior vena cava: 

• Transverse diameter up to 2.5 cm 

Lymph nodes larger than 1 cm are suspicious for pathology. 




Axial image 



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Upper Abdomial Organs 133 




Axial image 




Axial image 




-4c 



-7a 



Coronal image 



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134 MRI: Abdomen 



Liver 

The liver is orthotopic and presents normal size and smooth borders. It 
has a normal internal structure with no focal abnormalities. The intra- 
hepatic and extrahepatic bile ducts are not dilated. 
The gallbladder appears normal, displaying smooth borders and homo- 
geneous contents. 

The porta hepatis shows no abnormalities. 
Other visualized upper abdominal organs are unremarkable. 



Interpretation 

The liver appears normal. 



Checklist 

Liver • Position 

— Directly below the right hemidiaphragm 

• Size (see below) 

• Borders: 

— Smooth 

— Sharp 

• No focal abnormalities 

• Intrahepatic bile ducts: 

— Course (toward porta hepatis) 

— Width 

— No calculi 

— No air 

• Extrahepatic bile ducts: 

— Course (from porta hepatis to head of pan- 
creas) 

— Width (see below) 

— Homogeneous contents of fluid-equivalent 
signal intensity 

— No calculi 

— No air 



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Liver 135 



Spleen • 

Pancreas • 

• 

Para-aortic region • 
Kidneys • 

(if visualized) • 

• 

Intestinal • 

structures • 



Gallbladder: 

— Size (see below) 

— Contours (smooth and sharp) 

— Wall thickness (see below, no general or cir- 
cumscribed thickening) 

— No pericholecystic fluid 
Gallbladder contents: 

— Homogeneous 

— Fluid-equivalent signal intensity 

— No filling defects (calculi, polyps) 

— No air 
Porta hepatis: 

— Occupied by the hepatic artery, common bile 
duct, and portal vein 

— No masses 

— No lymphadenopathy 

Costophrenic sinus is clear and aerated on each 

side 

Normal size (see below) 

Homogeneous internal structure 

Normal size (see below) 

Pancreatic duct unobstructed (see below) 

Unremarkable 

Position 

Size 

Internal structure 

Normal 

No free extraintestinal or intra-abdominal air or 

fluid 



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136 MRI: Abdomen 



Important Data 

Dimensions: 

1 Liver: 

a Left lobe (anteroposterior diameter on the left paravertebral 

line): up to 5 cm 
b Right lobe (craniocaudal diameter measured on the mid- 
clavicular line): up to ca. 15 cm 
Angle of hepatic border: 

c Right side: ca. 75° (inferior border, sagittal plane) 
d Left side: ca. 45° (left lateral and inferior borders) 
e Caudate lobe/right lobe (CL/RL) = 0.37 ± 0.16 (e.g., 0.88 ± 0.2 
in cirrhosis). Reference lines [from medial side]: line I is tan- 
gent to the medial border of the caudate lobe; line II is paral- 
lel to I and tangent to the lateral aspect of the portal vein; 
line III is tangent to the lateral hepatic border and perpen- 
dicular to a line midway between the portal vein and infe- 
rior vena cava and perpendicular to I and II. 

2 Gallbladder: 

a Horizontal diameter up to 5 cm (> 5 cm is suspicious for hy- 
drops) 
b Width of gallbladder wall: 1-3 mm 

3 Width of common bile duct: 

• < 8 mm (after cholecystectomy: < 10 mm) 




T1 -weighted noncontrast axial image 



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Liver 137 




T2-weighted noncontrast axial image 




T1 -weighted axial image after the i.v. administration of a 
superparamagnetic contrast agent 




T2-weighted axial image after the i.v. administration of a 
superparamagnetic contrast agent 



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138 MRI: Abdomen 



Portal vein: 

• Up to 1.5 cm 
Hepatic veins: 

• Up to 0.5 cm 
Spleen: 

• Depth D): 4-6 cm 

• Widt(W): 7-10 cm 

• Length (L): 11-15 cm 

• Splenic index: DxWxL = between 160 and 440 
Adrenal glands (variable): 

• Crural thickness < 10 mm 
Kidneys: 

• Craniocaudal diameter: 8-13 cm 

• Anteroposterior diameter: ca. 4 cm 

• Transverse diameter: 5-6 cm 
Position of superior poles of kidneys: 

• Right: superior border of LI ; left: inferior border of T12 
Transverse renal axis: 

• Posteriorly divergent angle of 120° 




Sagittal image at the level of the mid- 
clavicular line 



Sagittal image through the left lobe of 
the liver 



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Liver 139 



Width of renal cortex: 

• 4-5 mm 

Diameter of abdominal aorta: 

• Approximately 18-30 mm 
Inferior vena cava: 

• Transverse diameter: up to 2.5 cm 

Lymph nodes larger than 1 cm are suspicious for pathology. 




Axial image 




Coronal image 



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140 MRI: Abdomen 



Kidneys 

Both kidneys appear normal in size and position, and the renal 
parenchyma displays normal width. There is no evidence of a mass. 
The calices are of normal shape, and the renal pelvis appears normal. 
The urinary drainage tract is unobstructed. 

Postcontrast images show a normal time to corticomedullary equi- 
librium and undelayed, symmetrical contrast excretion into the renal 
pelves. 

Other visualized upper abdominal organs, especially the adrenal glands, 
show no abnormalities. 



Interpretation 

Both kidneys appear normal. 



Checklist 
Kidneys 



Paired 

Position (see below) 

Size (see below) 

Contours: 

— Smooth 

Parenchymal width and signal (see below) 
Normal relation of cortex to medulla 
Renal pelves: 

— Structure 

— Bilateral symmetry 

— Width 

— Shape of calices 
Ureters: 

— One per side 

— Course 

— Width (see below) 

— No obstruction of urinary drainage 
Perirenal and pararenal spaces: 

— Fat signal 

Perirenal and pararenal fasciae: 

— Position 

— Width (no circumscribed thickening) 



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Kidneys 141 



Adrenal glands 



Retroperitoneal 
space 

Intestinal struc- 
tures (colon 
haustrations, 
small bowel) 
Major vessels 



Soft tissues 



Shape 

Size (see below) 

Slender crura 

No circumscribed expansion 

No abnormalities (mass, fluid) 

Normal 

Wall thickness 

No free extraintestinal or intra-abdominal air or 

fluid 

Course 

Caliber (see below) 

No lymphadenopathy (see below) 

Fat signal 

Bilateral symmetry 




T1 -weighted coronal image using breath-hold technique, early 
bolus phase 



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142 MRI: Abdomen 



Important Data 

1 Position of superior poles of kidneys: 

a Right: superior border of LI 

b Left: inferior border of T12 (variable; right kidney is lower 
than left kidney by up to one vertebral body height) 

2 Distance between superior renal poles: 

• Approximately 10 cm (4-16 cm) 

3 Distance between inferior renal poles: 

• Approx. 13 cm (9-18.5 cm) 

4 Transverse renal axis: 

• Posteriorly divergent angle of 120° 

5 Renal dimensions: 

• Craniocaudal 8-13 cm (<1.5 cm craniocaudal difference in 
renal sizes) 

Transverse renal diameter at level of hilum: 5-6 cm (b = 
transverse) x 3-4 cm (c = anteroposterior) 

6 Renal cortical thickness: 

• 4-5 mm 

7 Time to corticomedullary equilibrium: 

• 1 minute 

8 Contrast excretion into the pyelocaliceal system: 

• 3 minutes 

9 Width of ureter: 

• 4-7 mm 

10 Gerota fascia (thickness): 

• 1-2 mm 

11 Abdominal aorta: 

• Transverse diameter ca. 18-30 mm 

12 Inferior vena cava: 

• Transverse diameter up to 2.5 cm 

Lymph nodes larger than 1 cm are suspicious for pathology. 



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Kidneys 143 




T1 -weighted axial image without contrast medium 




T1 -weighted axial image after contrast administration 



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144 MRI: Abdomen 




T1 -weighted axial image after contrast administration 




T1 -weighted noncontrast axial image at the level of the ureters 



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Adrenal Glands 145 



Adrenal Glands 

Both adrenal glands present normal size and position with normally 
developed crura. There is no evidence of a mass or circumscribed ex- 
pansion. 

The adrenal compartment appears normal. 

Postcontrast images show normal adrenal enhancement characteristics 
and dynamics. 

No abnormalities are found in other visualized upper abdominal organs, 
especially the kidneys. 



Interpretation 

Both adrenal glands appear normal. 



Checklist 

Adrenal glands • Paired 

• Position (superior and anterior to kidneys) 

• Shape, size (see below) 

• Borders (smooth, sharp) 

• Signal characteristics of normal adrenals (Tl: 
slightly hypointense to liver; Tl fat-saturated: 
isointense; T2: hypointense; T2 fat-saturated: 
hyperintense) 

• No circumscribed hypointense, isointense or hy- 
perintense expansion of adrenal crura (e.g., T2- 
weighted signal is increased in many pheochro- 
mocytomas) or circumscribed hypointense or 
hyperintense lesions (e.g., calcifications, fat 
deposits) 

• Enhancement characteristics: 

— Adenomas show moderate signal increase 
that usually returns to initial level by 10 
minutes postinjection 

— Most malignant tumors still show intense en- 
hancement after 15 minuntes 

• Chemical shift imaging: 

— In-phase and out-of-phase Tl -weighted im- 
ages show fat intensity (decreased signal) in 
benign disease 



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146 MRI: Abdomen 



Liver 



Spleen 

Pancreas 
Kidneys 



Stomach and 
bowel 



Major blood 
vessels 
Lymph nodes 
Soft tissues 



Adrenal compartment: 

— Fat intensity 

— No masses 
Size (see below) 
Borders: 

— Smooth 

— Sharp 

Homogeneous internal parenchymal structure 

Intrahepatic and extrahepatic bile ducts 

Costophrenic sinus is clear and aerated on each 

side 

Size (see below) 

Smooth outer contours 

Homogeneous internal structure 

Size 

Pancreatic duct 

Paired 

Position (see below) 

Size (see below) 

Smooth contours 

Position 

Size 

No masses 

No infiltration 

Transverse diameter (see below) 

Flow 

No lymphadenopathy 



Important Data 

Dimensions: 

1 Adrenal glands (variable): 

• Crural thickness < 10 mm 
Kidneys: 

Position of superior poles of kidneys: 

• Right: superior border of LI 

• Left: inferior border of T12 
Transverse renal axis: 

• Posteriorly divergent angle of 120° 



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Adrenal Glands 147 



Thickness of renal cortex: 

• 4-5 mm 
Renal dimensions: 

• Craniocaudal diameter: 8-13 cm 

• Anteroposterior diameter: ca. 4 cm 

• Transverse diameter: 5-6 cm 
Gerota fascia (thickness): 

• 1-2 mm 
Spleen: 

• Width: 7-10 cm 

• Depth: 4-6 cm 

• Length: 11-15 cm 
Diameter of abdominal aorta: 

• Approximately 18-30 mm 




T2-weighted axial image through the adrenal glands 



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148 MRI: Abdomen 




T1 -weighted axial image, noncontrast and in-phase 




T1 -weighted axial image, noncontrast and out-of-phase 



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Adrenal Glands 149 




T1 -weighted axial image, postcontrast and in-phase 




T1 -weighted axial image, postcontrast and out-of-phase 



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150 MRI: Abdomen 



Female Pelvis 

The pelvic inlet appears normal, with normal configuration of the iliac 

wings and iliopsoas muscles. 

No abnormalities are found in imaged bowel structures, and there are 

no signs of wall thickening or mass lesions. 

The uterus is anteverted and has normal internal structure. The adnexa 

appear normal on both sides. 

The adequately distended urinary bladder appears normal and has a 

normal wall thickness. 

The vessels of the lesser pelvis are normal in course and caliber. There is 

no apparent lymphadenopathy. 

The femoral heads are normally shaped and articulate normally with 

the acetabula. They have normal bone-marrow signal characteristics. 

The soft tissues show no abnormalities. 



Interpretation 

The lesser pelvis appears normal. 



Checklist 
Pelvic inlet 



Iliopsoas muscles 



Intestinal struc- 
tures (especially 
the cecum and 
rectum) 

Perirectal fat 



Ischiorectal fossa 



Uterus 



Configuration 

Width 

Symmetry 

Iliac wings (shape) 

Size 

Signal characteristics 

Symmetry 

Position 

Wall thickness (if with normal distension, see 

below) 

No circumscribed wall thickening 

Well-opacified lumen with no soft-tissue mass 

Signal characteristics (fat intensity) 

No infiltration 

No masses 

Bilateral symmetry 

No masses 

No lymphadenopathy 

Position 

Size (see below) 

Borders (smooth outer contours) 



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Female Pelvis 151 



Cervix, vagina 



Ovaries 



Urinary bladder 



Vessels 



Lymph node 
stations 
Pelvic skeleton 



Subcutaneous 
tissue and 
muscles 



Signal characteristics 
Uterine cavity: 

— Configuration 

— Size 

— Signal characteristics 
Position 

Size 

Borders 

Position 

Size (see below) 

Signal characteristics 

Symmetry 

No masses of soft-tissue or fluid signal intensity 

Adequate distention 

Outer contours: 

— Smooth 

— Wall thickness (see below) 
Caliber (see below) 

Course 

No significant intimal calcifications 

No lymphadenopathy 

Configuration 

Margins (cortex smooth and sharp, no discon- 
tinuities) 

Fat-equivalent signal intensity of bone marrow 
No circumscribed areas of marrow replacement 
Femoral heads rounded and centered in 
acetabula 
Sacroiliac joints: 

— Smooth contours 

— Normal width (see below) 
Symphysis pubis (see below) 
Signal characteristics 
Extent 

Borders 
Symmetry 



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152 MRI: Abdomen 



Important Data 

Pelvic dimensions: 

1 True conjugate: 

• Approximately 11 cm 

2 Pelvic cavity: 

• > 12 cm 

3 Pelvic outlet: 

• Approximately 9 cm 

4 Transverse diameter (transverse interspinous distance): 

• Approximately 13 cm 

5 Uterus (variable): 

• Prepubescent: a, length up to 3 cm; b, transverse diameter 
ca. 1 cm 

• Nullipara: a, length up to 8 cm; b, transverse diameter ca. 
4 cm 

• Multipara: a, length up to 9.5 cm; b, transverse diameter ca. 
5.5 cm 

• Postmenopausal: a, length up to 6 cm; b, transverse diame- 
ter ca. 2 cm 

(Transverse diameter of upright uterus = well distended blad- 
der < 5 cm) 

6 Uterine cervix: 

a Craniocaudal < 2 cm 

b Transverse diameter < 3 cm 




Midsagittal image through the 
lower abdomen. 



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Female Pelvis 153 




Paracoronal image along the true conjugate (line 1 in Fig. 
on left [= midsagittal section through the lower abdo- 
men]). 




Coronal image 



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154 MRI: Abdomen 



7 Ovaries: 

• Prepubescent: a, length up to 2.5 cm; b, transverse diame- 
ter ca. 2.5 cm 

• Sexual maturity: a, length up to 4 cm; b, transverse diame- 
ter ca. 2.5 cm 

• Postmenopausal: a, length up to 3 cm; b, transverse 
diameter ca. 1.5 cm 

8 Urinary bladder (well distended): 

• Wall thickness ca. 3 cm 

9 Rectum: 

• Wall thickness < 5 mm 

10 Symphysis pubis: 

• Width < 6 mm 

11 Cartilage thickness of sacroiliac joint spaces: 

• 2-5 mm (anterior and inferior: 2-3 mm) 




Axial image 



Axial image 



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Male Pelvis 155 



Male Pelvis 

The pelvic inlet appears normal, with normal configuration of the iliac 

wings and iliopsoas muscles. 

No abnormalities are found in imaged bowel structures, and there are 

no signs of wall thickening or mass lesions. 

The distended urinary bladder appears normal and has normal wall 

thickness. The seminal vesicles are of normal size. The angle between 

the bladder and seminal vesicle is normal on each side. The prostate 

shows a normal size and configuration. 

The vessels of the lesser pelvis are normal in their course and caliber. 

There is no evidence of lymphadenopathy. 

The femoral heads are normally shaped and articulate normally with 

the acetabula. They have normal bone-marrow signal characteristics. 

The soft tissues show no abnormalities. 



Interpretation 

The lesser pelvis appears normal. 



Checklist 
Pelvic inlet 



Intestinal struc- 
tures (especially 
the cecum and 
rectum) 



Perirectal fat 



Ischiorectal fossa 



Seminal vesicles 



Configuration 

Width 

Symmetry 

Iliac wings (shape) 

Iliopsoas muscles: 

— Size 

— Signal characteristics 

— Symmetry 
Borders 
Position 

Wall thickness (if with normal distension, see 

below) 

No circumscribed wall thickening 

Well-opacified lumen with no soft-tissue mass 

Signal characteristics (fat intensity) 

No infiltration 

No masses 

Bilateral symmetry 

No masses 

No lymphadenopathy 

Position (behind the bladder) 

Size (see below) 



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156 MRI: Abdomen 



Prostate 



Urinary bladder 



Vessels 

Lymph node 
stations 
Pelvic skeleton 



Subcutaneous 
tissue and 
muscles 



Symmetry 

Angle between the bladder and seminal vesicle 
(see below) is clear on each side 
Signal characteristics 
Position (central at bladder outlet) 
Configuration (rounded shape, intact capsule 
and lobulation) 
Size (see below) 
Homogeneous signal intensity 
No calcifications 

No unilateral nonhomogeneity after contrast ad- 
ministration 
Adequate distension 
Smooth outer contours 
Wall thickness (see below) 
Caliber (see below) 
Course 
No lymphadenopathy 

Configuration 

Margins (cortex smooth and sharp, no discon- 
tinuities) 

Fat-equivalent signal intensity of bone marrow 
No circumscribed areas of marrow replacement 
Femoral heads rounded and centered in 
acetabula 
Sacroiliac joints: 

— Smooth contours 

— Width (see below) 
Symphysis pubis 
Density 

Extent 

Borders 

Symmetry 



Important Data 

1 Prostate (size varies with age, 20-70 years): 

a Anteroposterior diameter ca. 2.5-3 cm 

b Lateral diameter: 3-5 cm 

c Craniocaudal diameter: 3-5 cm 

2 Symphysis pubis: 

• Width < 6 mm 

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Male Pelvis 157 




Axial image 




Axial image 




Axial image 



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158 MRI: Abdomen 



Rectum: 

• Wall thickness < 5 mm 
Urinary bladder (well distended): 

• Wall thickness ca. 3 mm 
Seminal vesicles (highly variable): 
a Length: up to 5 cm 

b Width: up to 2 cm 

Angle between bladder and seminal vesicles: 

• Open = normal 

Width of sacroiliac joint spaces: 

• 2-5 mm (anterior and inferior: 2-3 mm) 




Coronal image 



Midsagittal image 



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Testes 159 



Testes 

The scrotum and its contents display normal configuration. 
The testes are symmetrical and of normal size with a homogeneous in- 
ternal structure. Each testis is sharply demarcated by the tunica al- 
buginea, which is of normal thickness. 

The epididymis shows a normal size and position on each side and pre- 
sents a normal internal structure. 

The scrotal compartments appear normal on each side, with no sign of 
increased fluid. 

The inguinal canal is normal in its shape, size, and course. 
The corpora cavernosa and corpus spongiosum are normal. 



Interpretation 

The testes appear normal. 



Checklist 
Scrotum 

Testes 



Tunica albuginea 

Epididymis 
(head and tail) 



Inguinal canal 



Corpora 
cavernosa 

Corpus 
spongiosum 



Size 

Configuration 
Paired 

Symmetrical 
Size (see below) 

Homogeneous internal structure (high T2- 
weighted signal intensity) 
No circumscribed or diffuse change in signal in- 
tensity 

Smooth, sharp borders on all sides 
Normal thickness 
Position 

Size (bilateral symmetry) 
Internal structure 

Scrotal compartments have smooth, sharp 
borders 

No increased fluid 
Shape 
Size 
Course 
Size 

Bilateral symmetry 
Honeycomb internal structure 
Size 
Urethra 



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160 MRI: Abdomen 



Important Data 

Testicular dimensions: 

1 Length: 

• Up to ca. 4 cm 

2 Transverse diameter: 

• Up to ca. 3 cm 




T2-weighted coronal image 



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Testes 161 




T1 -weighted axial image 



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162 

MRI: Spinal Column 

Cervical Spine 

The cervical spine shows a normal degree of lordosis with normal width 
of the bony spinal canal. 

The vertebral bodies are normal in their number, shape, and interrela- 
tionships. 

The atlantodental distance is normal. The articulating vertebral end 
plates present smooth margins. The intervertebral disk spaces are of 
normal height. 

The intervertebral disks do not project past the posterior surface of the 
vertebral bodies in any imaged segment. 

The spinal cord, including the craniocervical junction, displays normal 
position, configuration, width, and internal structure. The bone marrow 
of the vertebral bodies appears normal. 
The prevertebral and paravertebral soft tissues show no abnormalities. 

Interpretation 

The cervical spine appears normal. 

Checklist 

Position • Normal cervical lordosis (no hypolordosis or hy- 

perlordosis, no kyphotic deformity) 

• No segmental malalignment 

• Normal position of the dens (see below) 
Bony spinal canal • Width (see below) 

• Smooth margins 
Vertebral bodies • Number (seven) 

• Shape (square except for the dens) 

• Position (straight alignment of posterior mar- 
gins, no steps) 

• End plates 

— Continuous margins (no discontinuities) 

— Smooth contours 

— No circumscribed depression 

— No marginal osteophytes 



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Cervical Spine 163 



Intervertebral 
disk space 



Spinal cord 



Nerve roots 



Neuroforamina 



Facet joints 



Spinous 
processes 



Soft tissues 



Width (see below) 

Normal signal characteristics: moderate to 
slightly hyperintense T2-weighted intensity (not 
hypointense to other disks) 
No disk protrusion past posterior surface of adja- 
cent vertebral bodies 
Configuration 
Width 

Signal characteristics 

No circumscribed change in signal intensity 
No circumscribed narrowing or expansion 
Course 

Passage through the neuroforamina 
Dural tube: 

— Shape 

— Width 

— No circumscribed narrowing or expansion 

— Perimedullary contents of fluid signal inten- 
sity 

Configuration 

Width 

No hypertrophy of uncovertebral joints 

Shape 

Position 

Contours (smooth, continuous) 

No hypertrophy 

Vertebral arches intact 

No shortening of pedicles 

Shape 

Position 

Size 

Bony structure 

Fat-equivalent signal intensity of bone marrow 

No circumscribed hypointense or hyperintense 

areas 

Symmetrically arranged on both sides of the 

vertebral bodies and spinous processes 

No masses 

Prevertebral soft-tissue structures (especially 

the pharynx and thyroid gland; no masses) 



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164 MRI: Spinal Column 



Important Data 

1 Atlantodental distance: 

a Sagittal plane: approx. 1-3 mm (up to 5 mm in children) 
b Coronal and axial planes: dens is centered 

2 Craniovertebral angle (angle formed by the basilar line and 
the posterior tangent to C2): 

• Normal range of 150° (flexion) to 180° (extension) (spinal 
compression occurs at less than 150°) 

3 Chamberlain's line (line connecting the posterior border of 
the hard palate with the posterior rim of the foramen 
magnum): 

• Tip of the dens should project no more than 1 mm ± 
6.6 mm above the line 

4 Retropharyngeal space: 

• Up to 7 mm (at level of C2) 

5 Width of spinal cord: 

• Sagittal > 6-7 mm 

6 Sagittal diameter: 

• CI > 21 mm 

• C2 > 20 mm 

• C3 > 17 mm 

• C4-C7 = 14 mm 

7 Height of intervertebral disk spaces: 

• C2 < C3 < C4 < C5 < C6 > C7 

8 Retrotracheal space: 

• Up to 22 mm (at level of C6) 

9 Anteroposterior diameter of preodontoid space: 

• <2 mm 

10 Width of spinal canal: 

• Transverse diameter at level of pedicles > 20-21 mm 



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Cervical Spine 165 




T2-weighted midsagittal image 




T2-weighted sagittal image 



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166 MRI: Spinal Column 




Axial image at the level of the dens 



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Cervical Spine 167 




Axial image at the level of the dens 




-10 



Axial image at the level of the laminae 



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168 MRI: Spinal Column 



Thoracic Spine 

The thoracic spine shows a normal degree of kyphosis with a normal 
width of the bony spinal canal. 

The vertebral bodies are normal in their number, shape, and interrela- 
tionships. The articulating vertebral end plates present smooth mar- 
gins. The intervertebral disk spaces are of normal height, and the disks 
do not project past the posterior surface of the vertebral bodies in any 
segment. 

The spinal cord displays normal course, configuration, width, and inter- 
nal structure. 

The bone marrow of the vertebral bodies appears normal. 
The prevertebral and paravertebral soft tissues show no abnormalities. 

Interpretation 

The thoracic spine appears normal. 



Vertebral bodies • 



Checklist 

Position • Thoracic kyphosis (see below) 

• No segmental malalignment 
Bony spinal canal • Width (see below) 

• Smooth margins 
Number (12) 
Shape (square) 

Position (straight alignment of posterior mar- 
gins, no step) 
End plates 

— Continuous margins 

— No circumscribed depression 

— Smooth contours, no marginal osteophytes 
Width (see below) 

Normal signal characteristics: moderate to 
slightly hyperintense T2-weighted signal inten- 
sity (not hypointense to other disks); "nuclear 
cleft" signifies an adult disk 
No disk protrusion past posterior surface of adja- 
cent vertebral bodies 
Configuration 
Width 
Signal characteristics 



Intervertebral 
disk space 



Spinal cord 



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Thoracic Spine 169 



Nerve roots 
Dural sack 

Neuroforamina 
Facet joints 



Spinous 
processes 



Soft tissues 



Aorta 



No circumscribed signal changes 

No circumscribed narrowing or expansion 

Course 

Passage through the neuroforamina 

Shape 

Width 

No circumscribed narrowing or expansion 

Contents of fluid intensity 

Configuration 

Width 

Shape 

Position 

Contours (smooth, continuous) 

No hypertrophy 

Vertebral arches intact 

Pars interarticularis intact 

No cleft anomalies 

No shortening of pedicles 

Shape 

Position 

Size 

Bony structure 

Fat-equivalent signal intensity of bone marrow 

No circumscribed hypointense or hyperintense 

areas 

Symmetrically arranged on both sides of the 

vertebral bodies and spinous processes 

No masses 

Prevertebral soft-tissue structures 



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170 MRI: Spinal Column 



Important Data 

1 Kyphotic angle (of Stagnara): 

• Angle formed by a line parallel to the vertebral end plates of 
T3 and Til = 25° 

Width of spinal canal: 

2 Transverse diameter at level of pedicles: 

• > 20-21 mm 

3 Sagittal diameter: 

• Tl-Tll = 13-14 mm 

• T12 = 15 mm 

4 Width of intervertebral disk spaces: 

• Smallest at Tl 

• T6-T11: ca. 4-5 mm 

• Largest at T11-T12 




T2-weighted midsagittal image 



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Thoracic Spine 171 




Axial image at the level of the laminae 




Coronal image 



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172 MRI: Spinal Column 



Lumbar Spine 

The lumbar spine shows a smooth lordotic curve with a normal prom- 
ontory angle. The bony spinal canal displays normal width. 
The vertebral bodies are normal in their number, shape, and interrela- 
tionships. The articulating vertebral end plates present smooth mar- 
gins. The intervertebral disk spaces are of normal height, and the disks 
do not project past the posterior surface of the vertebral bodies in any 
segment. 

The conus medullaris terminates normally at the LI level and divides 
into its filaments. 

The dural tube appears normal in its lumbar portion and evaluable 
sacral portion. 

The bone marrow of the vertebral bodies appears normal. 
The imaged soft tissues show no abnormalities. 



Interpretation 

The lumbar spine appears normal. 



Checklist 
Position 



Bony spinal 
canal 
Vertebral bodies 



Intervertebral 
disk space 



Lumbar lordosis (see below) 
Lumbosacral angle (see below) 
No segmental malalignment 
Width (see below) 
Smooth margins 
Number (five) 
Shape (square) 

Position (straight alignment of posterior mar- 
gins, no step) 
End plates 

— Continuous margins 

— No circumscribed depression 

— Smooth contours 

— No marginal osteophytes 
Width (see below) 

Normal signal characteristics: moderate to 
slightly hyperintense T2-weighted signal inten- 
sity (not hypointense to other disks); "nuclear 
cleft" signifies an adult disk 



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LumbarSpine 173 



Conus medullaris • 



Nerve roots 



Bony portions of 
vertebral bodies 



No disk protrusion past posterior surface of adja- 
cent vertebral bodies (posterior disk contours on 
axial images: concave at L1-L4, straight at L4/5, 
slightly convex at L5/S1) 
Configuration 
Width 

No circumscribed narrowing or expansion 
Position (terminates at approximately the LI 
level) 

Normal division into filaments 
Signal characteristics 
Filaments: 

— Course (sweeping, not straight; no posterior 
adhesions) 

— Width 

— No circumscribed mass 
Course 

Passage through neuroforamina 
Dural sac: 

— Shape 

— Width 

— No circumscribed narrowing or expansion 

— Contents of fluid intensity 
Neuroforamina: 

— Configuration 

— Width 
Facet joints: 

— Shape 

— Position 

— Contours (smooth, continuous) 

— No hypertrophy of facet joints 
Vertebral arches intact 

Pars interarticularis intact 
No cleft anomalies 

— No shortening of pedicles 

— Spinous processes: 

— Shape 

— Position 

— Size 

— Bony structure 

Fat-equivalent signal intensity of bone marrow 

— No circumscribed hypointense or hyper- 
intense areas 



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174 MRI: Spinal Column 



Soft tissues • Symmetrically arranged on both sides of the 

vertebral bodies and spinous processes 

• Prevertebral soft-tissue structures 

• No masses 



Aorta, iliac vessels 



Important Data 


1 


Width of intervertebral disk space and height of lumbar in- 




tervertebral disks: 




• 8-12 mm 




• Increases from LI to L4/5 




• Usually decreases at L5/S1, but may be the same as or 




greater than L4/5 


2 


Lordosis (static axis): 




• Plumb line from center of L3 should intersect SI 


3 


Lumbosacral angle (Sl/horizontal plane) = 26-57° 


4 


Width of spinal canal: sagittal diameter: 




• 16-18 mm (simple formula: not less than 15 mm; 11- 




15 mm = relative stenosis, less than 10 mm = absolute ste- 




nosis) 


5 


Width of spinal canal: transverse diameter (at level of 




pedicles): 




• L1-L4: > 20-21 mm 




• L5: >24mm 


6 


Jones-Thomson ratio (= AxB/CxD): 




• Between 1 /2 and 1 /4.5 = normal (denominator > 4.5 = spinal 




stenosis) 


7 


Lateral recess (sagittal diameter): 




• > 4-5 mm 


8 


Ligamenta flava: 




• Width < 6 mm 



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Lumbar Spine 175 




T2-weighted sagittal image at level 
of lateral recess 




T2-weighted midsagittal image 



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176 MRI: Spinal Column 




T2-weighted axial image at level of pars interarticularis 




T1 -weighted axial image at level of neuroforamina 



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Lumbar Spine 177 




Coronal image 



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178 MRI: Spinal Column 



Sacroiliac Joints 

The sacroiliac joints are normally shaped with normal development of 
the sacrum and iliac wings and a normal-appearing lumbosacral junc- 
tion. The joint space is of normal width on both sides. The joint contours 
are smooth and sharply defined. 

The subchondral bone marrow appears normal. There are no marginal 
osteophytes. 

The sacrum and iliac wings also contain normal bone marrow and pre- 
sent smooth, intact cortical boundaries. The sacral neuroforamina are of 
normal width. 

The nerve filaments shows a normal course and diameter, and the 
width of the sacral spinal canal is normal. 

The muscles and the imaged organs of the lesser pelvis show no abnor- 
malities. 



Interpretation 

The sacroiliac joints appear normal. 



Checklist 

Joint • Shape: 

— Articular surfaces converge posteriorly 

— Bilateral symmetry 

• Contours: 

— Margins: smooth, sharp 

— Cortical thickness (uniform) 

— No steps or discontinuities 

— No marginal osteophytes 

• Joint space: 

— Uniform normal width (see below) 

— No circumscribed narrowing or expansion 

— No obliteration (ankylosis) 

— No unilateral increase in joint fluid 

— No signal voids within the joint space (air, cal- 
cifications) 

— No marginal osteophytes (caution: the ileum 
normally contains areas of hyperostosis) 

— Normal thickness of articular cartilage (see 
below) 

— No abnormal contrast enhancement 

— No thickening of joint capsule 



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Sacroiliac Joints 179 



Sacrum 



Iliac wings 



Lumbar spine 



Subchondral region: 

— Homogeneous, fat-equivalent signal intensity 
of bone marrow 

— No erosive or destructive changes 

— No increase in T2-weighted signal intensity 
(e.g., circumscribed due to cysts or patchy due 
to bone-marrow edema) 

— No decrease in Tl -weighted or T2 -weighted 
signal intensity (e.g., sclerosis on the sacral 
side or fatty infiltration of the periarticular 
bone marrow) 

Anatomy (four vertebral bodies, four neuro- 
foramina) 
Shape 

Symmetry (lateral sacral mass) 
Width and arrangement of neuroforamina 
Bone marrow signal (fat-equivalent, no marrow- 
replacing process) 
Bony spinal canal (width) 
Shape (closed) 

Dural tube (width, no circumscribed narrowing 
or expansion) 

Filaments have normal size and arrangement, 
and are not fused together; no posterior adhe- 
sions 

Sacral plexus (course, width) 
Shape 
Symmetry 

Margins: smooth, sharp 

Cortical thickness (continuous and uniform; no 
steps or discontinuities) 

Bone marrow signal (fat-equivalent, no marrow- 
replacing process) 
Symphysis and femoral heads 
Position: 

— Lumbar lordosis (sagittal survey image) 
Lumbosacral angle (see below) 

Bony spinal canal (shape, width— see below) 

Vertebral bodies (shape, margins, bone-marrow 

signal) 

Height of intervertebral disk spaces 

Intervertebral disks 

Dural tube 



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180 MRI: Spinal Column 



• Neuroforamina 

• Nerve roots: 

— Origin and course 

• Facet joints 

• Vertebral arches intact 

• Spinous processes 

• Coccyx (shape, structure, position— see below) 
Soft tissues • Muscles (especially the iliac, psoas, gluteals, and 

intrinsic back muscles) 

• Fat and intra-abdominal structures (e.g., sigmoid 
colon and rectum, bladder, prostate or uterus 
and ovaries) 

• No masses 
Vessels • Aorta 

• Iliac arteries 

• Vena cava 

• Iliac veins 

Lymph nodes • Lymph node stations (particularly the iliac 
nodes) 



Important Data 

1 Lumbosacral angle (SI /horizontal plane): 

• 26-57° 

2 Angle between sacrum and coccyx: 

• Anterior angle ca. 10-30° (sagittal survey image, large range 
of variation) 

3 Width of joint space: 

• 4-5 mm 

4 Articular cartilage: 
a Sacral: 3 mm 

b Iliac: 1 mm 



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Sacroiliacjoints 181 




Sagittal image 




Paracoronal image parallel to the sacrum 



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182 MRI: Spinal Column 




-4a 
-4b 



Para-axial image at right angles to sacrum 



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183 



MRI: Joints 



Temporomandibular Joint 

The mandibular condyle has normal configuration and articulates with 
a normally shaped glenoid fossa. 

The joint space is of normal width, and the articular surfaces have 
smooth, sharp borders. Cortical thickness and signal intensity of the 
bone marrow are normal. 

The articular disk presents a hoodlike configuration on paracoronal im- 
ages. It is dumbbell-shaped on parasagittal images. The posterior liga- 
ment is at approximatley the 11 o'clock position relative to the cir- 
cumference of the mandibular condyle. 

When the mouth is opened, the articular disk follows the movement of 
the mandibular condyle onto the articular tubercle. 
Imaged portions of the paranasal sinuses are clear and pneumatized. 
Imaged portions of the neurocranium show no abnormalities. 

Interpretation 

The temporomandibular joint appears normal. 



Checklist 

Mandibular 

condyle 

Glenoid 



Cylindrical shape (coronal plane) 

Spherical shape (sagittal plane) 

Shape (posteriorly convex, largely congruent 

with the mandibular condyle when the mouth is 

closed) 

Articular surfaces: 

— Margins (smooth, sharp) 
Joint space: 

— Width (see below) 

— No effusion 
Cortex: 

— Thickness 

— No subchondral changes 

— No osteophytes 



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184 MRI: Joints 



Articular disk 



Surrounding 
soft tissues 



Bony boundaries 
(skull base supe- 
riorly, external 
auditory canal 
and mastoid 
posteriorly) 
Adjacent struc- 
tures (temporal 
lobe, mastoid 
process) 

Paranasal sinuses 
(if imaged) 



Signal intensity of bone marrow (fat-equivalent) 
No circumscribed signal changes 
Coronal plane: 

— Configuration (tubular or cylindrical) 

— Width (approximately uniform, 2-3 mm 
thick) 

— Position (surmounts mandibular condyle like 
a hood, does not project past medial or lateral 
aspect of condyle) 

Sagittal plane: 

— Configuration (dumbbell-shaped: anterior 
ligament, intermediate zone, posterior liga- 
ment) 

— Position: 

— With mandible in resting position, posterior 
ligament is at about the 11-12 o'clock posi- 
tion relative to circumference of mandibular 
condyle 

— When mouth opens, articular disk moves 
with condyle (anterior ligament is anterior to 
condyle or at about the 11 o'clock position 
relative to condyle circumference) onto the 
articular tubercle 

Muscles (particularly the masseter and lateral 

pterygoid) 

Normal-appearing periarticular fat 

No masses 

No infiltration 

Smooth 

Sharp 

Intact 



Unremarkable 



Clear and pneumatized 



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Temporomandibularjoint 185 



Important Data 

1 Posterior ligament: 

• With jaw in resting position, between 11 and 12 o'clock 




Parasagittal image with the mouth closed 




Parasagittal image with the mouth open 



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186 MRI: Joints 



Shoulder Joint 

The humeral head has normal configuration and articulates properly 
with the normally developed glenoid. The articular surfaces are smooth 
and show normal cortical thickness. The width of the joint space is nor- 
mal. The bone marrow displays homogeneous, fat-equivalent signal in- 
tensity. 

The glenoid labrum is intact on all sides. 

The acromioclavicular joint has normal configuration, with no hyper- 
trophy. The subacromial fat is intact. 

The muscles comprising the rotator cuff show normal course and con- 
figuration. In particular, the supraspinatus muscle is normal in its posi- 
tion, width, and signal characteristics and shows a normal musculoten- 
dinous junction. 

The intact biceps tendon appears normal and occupies a normal posi- 
tion in the bicipital groove. 

The other muscles that cover the shoulder joint appear normal, as do 
imaged portions of the lungs and soft tissues. 

Interpretation 

The shoulder joint appears normal. 



Checklist 
Humeral head 



Joint space 



Position (centered in the shoulder joint; does not 
ride high in the glenoid) 

Configuration (rounded cross section). (Caution: 
the bicipital groove appears anteriorly and the 
tuberosity posteriorly, but the highest axial sec- 
tion is always circular— useful for excluding a 
proximal depressed fracture = Hill-Sachs lesion) 
Contours (smooth and sharp) 
No osteophytes, especially in fovea area 
Bone marrow signal: 

— Homogeneous, fat-equivalent intensity (in 
humeral head and shaft) 

— "Adolescent" bone marrow signal before age 
25 years 

— No subchondral signal changes 

— Normal articular cartilage 
Width (see below) 

No increase of intra-articular fluid 



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Shoulderjoint 187 



Glenoid 



Acromion, 
clavicle 



Acromioclavi- 
cular joint 



Rotator cuff 

(supraspinatus, 

infraspinatus, 

subscapularis, 

teres minor 

muscles) 

Biceps tendon 



Muscles covering 
the shoulder 
joint (especially 
the deltoid) 
Lungs, soft tissues 



Size congruent with humeral head 
Smooth articular surface 
Cortex (thickness, no discontinuities) 
No osteophytes 
No subchondral erosion 
Bone marrow signal 
Articular cartilage 

Glenoid labrum is triangular about its whole cir- 
cumference and is firmly attached to the glenoid. 
(Caution: variant often seen in the anterosupe- 
rior quadrant should not be mistaken for a tear! ) 
Normal development of the acromion (straight, 
curved, hook-shaped, upslope angle— see below) 
and clavicle 
Smooth, sharp margins 
Normal bone-marrow signal 
Configuration 
Width (see below) 
No hypertrophy 
Normal subacromial fat layer 
Subacromial bursa is not fluid-filled, fat stripe of 
bursa is visible and undisplaced 
Configuration 
Position 

Course (over humeral head) 
Homogeneous signal intensity of tendon 
No hyperintense signal (on T2-weighted images) 
No peritendinous fluid 

Long tendon segment runs in bicipital groove 
Hypointense 
No discontinuities 
Normal width 

No increase of fluid in long biceps tendon sheath 
No fluid in other bursae (especially the subcora- 
coid and subdeltoid) 
Shape 
Position 
Signal intensity 



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188 MRI: Joints 



Important Data 


1 


Glenoid angle: 




• Approx. 5° of retroversion (i.e., angle between the glenoid 




and a perpendicular to the scapular long axis is slightly 




open posteriorly, but the range of variation is large) 


2 


Joint space: 




• Shoulder joint: < 6 mm 


3 


Acromioclavicular joint: 




• Width < 1 cm 


4 


Angle of acromion upslope (oblique sagittal image plane): 




• 10-40° 


5 


Diameter of biceps tendon: 




• Approximately 4-6 mm 


6 


Bicipital groove: 




• Width: 7-9 mm 




• Depth: 4-7 mm 




The bicipital groove starts at least 20 mm below the tip of the 




humeral head. (This differentiates the groove from a Hill-Sachs 




lesion, which often occurs at a higher level.) 




Axial image 



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Shoulder Joint 189 




Axial image 




Paracoronal image parallel to the supraspinatus muscle 



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190 MRI: Joints 




Parasagittal image at right angles to the supraspinatus muscle 



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Ellbowjoint 191 



Elbow Joint 

The elbow joint shows normal configuration with normal articulation 
of the bone ends. The articular surfaces are smooth and congruent, 
especially in the radiohumeral and ulnohumeral joints, with no discon- 
tinuities. There are no osteophytes or subchondral joint changes. 
The joint spaces are of normal width. The olecranon fossa is clear, and 
there are no intra-articular loose bodies. 

The cortex of the tubular bones is of normal thickness. The bone-mar- 
row signal is normal. 

Imaged ligamentous structures appear normal, particularly the annular 
ligament. 

The ulnar, radial, and median nerves display a normal course and 
diameter. 
The imaged muscles show no abnormalities. 

Interpretation 

The elbow joint appears normal. 



Checklist 

Radius, ulna, 
humerus 

Joint 



Cubital tunnel 



Normal configuration 

Articulation 

Position (see below) 

Articular surfaces are smooth and congruent, 

especially in the radiohumeral and ulnohumeral 

joints 

Normal cortical thickness 

No discontinuities in the articular surfaces 

No marginal osteophytes 

No subchondral joint changes 

Normal olecranon fossa 

Joint spaces: 

— Width 

— No loose bodies 

— No effusion 

— No synovial folds in radiohumeral joint 
Shape 

Depth 
Retinaculum 



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192 MRI: Joints 



Other bony • Cortex of tubular bones (width, contours) 

structures • Bone marrow signal (normal for age, fat-equiv- 

alent; adolescent signal before age 25) 
Muscles and • Position 

ligaments • Width 

• Signal characteristics 

• No thinning or discontinuities 

• Muscle and tendon attachments: signal inten- 
sity, width, no discontinuities, no signs of tennis 
elbow: 

— No widening or abnormal enhancement of 
extensor tendon (next to radial epicondyle of 
humerus) 

— No increased water content of anconeus 
muscle 

• Bursae (e.g., radial bicipital bursa proximal to ten- 
don insertion, olecranon bursa) are not fluid- 
filled 

• Ligaments are intact (e.g., medial collateral liga- 
ment complex = posterior, transverse ligament 
and functionally important anterior ligament; 
lateral collateral ligament complex = medial col- 
lateral ligament, annular ligament, lateral ulnar 
collateral ligament, joint capsule) 

• No circumscribed thinning or expansion 

• Smooth borders 

• Homogeneous signal intensity 

• No increase in peritendinous fluid 
Soft tissues • Ulnar, radial and median nerves: 

— Course 

— Diameter 

• Normal ulnar groove 



Important Data 

1 Carrying angle of elbow: 

• 162° 

2 Angle of trochlear axis to ulnar axis: 

• 79° 

3 Angle of trochlear axis to humeral axis: 

• 83° 



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Ellbowjoint 193 




Coronal image 




Sagittal image at level of olecranon 



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194 MRI: Joints 




Sagittal image at level of radius 




Axial image at level of radial head 



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Wrist 195 



Wrist 

The bones comprising the wrist present a normal configuration. 
The radial joint angle is normal. The carpal bones show normal shape 
and relationship to one another and to the radiocarpal and carpometa- 
carpal joints. 

The articular surfaces are smooth and congruent with normal cortical 
thickness and normal width of the joint spaces. There are no 
osteophytes and no subchondral signal changes. The bone marrow sig- 
nal is normal. 

The ulnar (triangular) disk exhibits normal configuration and normal 
signal characteristics. The interosseous ligaments also appear normal. 
The carpal tunnel is of normal width and transmits tendons that are 
normal in width and position. The median and ulnar nerves appear nor- 
mal. 

The metacarpals and phalanges have normal margins and normal bone- 
marrow signal intensity. The soft tissues are normal. 



Interpretation 

The wrist and hand appear normal. 



Checklist 

Bony structures • Radius 

• Ulna (configuration, no shortening) 

• Carpal bones (proximal and distal rows) 

• Metacarpals 

• Radiocarpal angle (see below) 

• Carpal bones: 

— Shape and position (see below) 

• Metacarpals and phalanges: 

— Five digital rays 

— Shape 

— Normal bone marrow signal 

• Articular surfaces, especially of radiocarpal and 
carpometacarpal joints: 

— Smooth 

— Congruent 

• Normal cortical thickness 

• No marginal osteophytes 

• No subchondral signal changes 

• Normal width of joint space (see below) 



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196 MRI: Joints 



Ligamentous 
structures 



Carpal tunnel 



Median nerve 



Ulnar nerve 



Soft tissues 



Ulnar (triangular) disk: 

— Configuration (see below) 

— Margins 

— Internal structure (hypointense expansion to 
styloid attachment and to radial end of ulna 
with central rarefaction) 

— No signal abnormalities 

— No discontinuities 

Interosseous ligaments: scapholunate and luna- 
totriquetral ligaments and ligaments of the distal 
row of carpal bones 

— Shape 

— Signal intensity 

— Contours (smooth, intact) 
Extrinsic ligaments: 

— Shape 

— Signal intensity 

— Contours (smooth, intact) 
Width (see below) 

Tendons (tendon sheaths in six compartments, 
thickness, position, symmetry) 
Flexor retinaculum (no palmar convexity) 
No circumscribed widening of tendons 
No thickening of tendon sheath walls 
No increase of fluid in tendon compartment 
No fluid-filled cyst 
No ganglion 
Course 
Width 

No impingement, especially in the carpal tunnel 
(axial image) 

No diffuse or circumscribed swelling (e.g., com- 
mon at level of pisiform bone) 
No narrowing (e.g., common at level of hamate 
bone) 

No signal changes 
Width 
Course 

No expansion 
No bony impingement 
No subcutaneous nodules 



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Wrist 197 




Coronal image 



-1a 




5b 



Coronal image 



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198 MRI: Joints 



Important Data 

1 Radiocarpal angle: 

a Coronal: 10-30° 
b Lateral: 10-15° 

2 Ulnar (triangular) disk or triangular fibrocartilage complex 
(TFC): 

• Maximum thickness: 1.6 cm ± 0.5 cm 

3 Inclination of lunate bone relative to long axis (lateral view): 

• 0-30° 

4 Inclination of scaphoid bone relative to long axis (sagittal 
view): 

• 30-60° 

5 Joint spaces: 

a Distal radioulnar joint: ca. 3 mm 
b Other joints: ca. 2 mm 

6 Distal radioulnar length relation: 

• 1-5 mm 

• > 5 mm = ulnar shortening 

• < 1 mm = ulnar lengthening 

7 Lines are drawn tangent to the corners of the radial ulnar 
notch and to the base points of the roughly triangular cross 
section of the distal ulna. Lines are drawn perpendicular to 
these tangents, and the angle between them is measured: 

• In neutral position +15° - +45°, in supination approx. 
+ 100°. Always compare with the opposite side. 




Axial image at level of distal radioulnar joint 



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Wrist 199 




Sagittal image 




Sagittal image 



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200 MRI: Joints 



Hip Joint 

The femoral heads and acetabula are of normal shape, and the femoral 
heads are well covered by the acetabular margins. The joint spaces are 
of normal width. 

The articular surfaces are smooth and congruent and show normal cor- 
tical thickness. There are no marginal osteophytes or subchondral signal 
changes. 

The bone marrow shows normal signal intensity, especially in the 
femoral head and neck. Each femoral shaft has normal margins and con- 
tains a normal bone marrow signal. 
The imaged muscles and the lesser pelvis show no abnormalities. 

Interpretation 

The hip joints appear normal. 



Checklist 

Hip joint • Femoral heads: 

— Shape 

— Bilateral symmetry 

• Acetabula: 

— Shape 

— Roundness 

— Symmetry 

• Position: 

— Femoral heads articulate with the acetabula 

— Femoral heads are well covered by the 
acetabular margins (see below) 

• Normal width of joint space 

• Articular surfaces: 

— Contours (smooth and congruent) 

• Normal cortical thickness on the articular sur- 
faces 

• No marginal osteophytes 

• No subchondral signal changes 

• Femoral head and neck: 

— Shape 

— Position 

— Normal femoral neck angle (CCD angle) (see 
below) 



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Hipjoint 201 



• Bone marrow signal: 

— Homogeneous 

— Fat-equivalent intensity 

— No circumscribed "double line sign" (femoral 
head necrosis) or patchy bone marrow edema 

Other structures • Femoral shaft: 

— Smooth margins 

— Normal cortical thickness 

— Bone marrow signal appropriate for age ("ad 
olescent" signal before age 25) and homog- 
eneous 

• Musculature: 

— Anatomy 

— Course 

— Bilateral symmetry 

— Homogeneous signal intensity 

— No circumscribed hypointense or hyper- 
intense areas 

• Major nerves and blood vessels: 

— Course 

— No circumscribed expansion 

• No lymphadenopathy 

• Structures of the lesser pelvis (bladder, prostate, 
and seminal vesicles or uterus and adnexa, in- 
testinal structures, lymph node stations) 



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202 MRI: Joints 




T2-weighted coronal image 




Sagittal image 



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Hip Joint 203 




Axial image 



Important Data 

1 Center-edge angle of Wiberg: 

• 26-30° 

2 CCD angle: 

• Approximately 125-135° 

3 Slope of acetabular roof: 

• <10° 

4 Femoral head coverage by the acetabulum: 

• Approximately 70% of articular surface 



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204 MRI: Joints 



Knee Joint 

The bones comprising the knee joint show normal configuration and 
position. The bone marrow signal is normal, with a normal trabecular 
pattern and normal epiphyseal lines. 

The cortex shows smooth contours and normal thickness with no sub- 
chondral signal changes. 

The cartilage covering the patella, femoral condyles, and tibial plateau is 
of normal thickness and has normal signal characteristics. The car- 
tilaginous surface is smooth. 

The medial and lateral menisci of the knee joint present a normal tri- 
angular configuration on axial images and have a homogeneous inter- 
nal structure of low signal intensity. The anterior horn, midportion, and 
posterior horn each display a smooth, intact surface. 
The anterior and posterior cruciate ligaments are intact and are normal 
in their width and signal characteristics. The collateral ligaments are in- 
tact and of normal width. 

The soft tissues surrounding the knee joint and the imaged vascular 
structures are unremarkable. 

Interpretation 

The knee joint appears normal. 



Checklist 

Configuration 
and position 



Bone marrow 
signal 



Cortex 



Femur 
Tibia 
Fibula 

Patella (shape, centering— see below) 
Fat-equivalent 
May be slightly patchy 

Adolescent bone marrow signal before age 25 
years 

No bone marrow edema 
No contusions 
Normal trabecular pattern 
Epiphyseal plate closure after age 18 
Thickness 
Contours (smooth) 

No subchondral signal changes in the bone mar- 
row 



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Knee Joint 205 



Articular cartilage 
(patella, femoral 
condyles, tibial 
plateau) 
Joint space 



Medial and 
lateral menisci 
(anterior horn, 
midportion, 
posterior horn) 
Anterior and 
posterior cruciate 
ligaments 



Collateral 
ligaments 



Soft tissues and 
imaged vessels 



Thickness (see below) 
Signal characteristics 
Cartilage surface (smooth) 

Width 

No effusion 

No intra-articular foreign bodies 

No abnormal synovial folds (especially the 

mediopatellar fold) 

Configuration (normal triangular cross section) 

Internal structure (homogeneous, hypointense) 

Contours (smooth, intact surface) 



Continuity 
Width 

Course (see below) 

Signal intensity (anterior cruciate ligament light 
and dark, posterior cruciate ligament uniformly 
dark) 
Position 
Width 
Continuity 
Low signal intensity 

No masses (e.g., Baker cyst, popliteal cyst, gan- 
glion) 
No varices 



Important Data 

Patella: 

Shape: Wiberg I— III (see drawing) 

Centering 

1 Patellar tilt angle (formed by a line parallel to the lateral 
patellar articular surface and a line parallel to the posterior 
aspect of the femoral condyles [may be drawn in sections at 
various levels, if necessary]): 



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206 MRI: Joints 



Congruence angle (formed by the bisector of the notch angle 
and a line connecting the patellar apex with the deepest point 
of the notch): 

• 6° to -6° 
Notch angle: 

• 135-145° (average ca. 138°) 
Lateral displacement: 

• < 5% (i.e., less than 5% of the patella is lateral to a line that is 
perpendicular to the line joining the femoral condyles at the 
level of the lateral condyle) 

Patellar ligament: 

a Length: 3.5-5.5 cm 

b Width: 2.5-3 cm 

c Thickness: 7 mm 

Ratio of length of patellar ligament to height of patella = 

0.8-1.2 (> 1.2 = high-riding patella) 

Cartilage: 

a Patella: 3-4 ± 1 mm 

b Femoral condyles and tibial plateau: ca. 2.2 ± 0.6 mm 




Axial image 



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Knee Joint 207 




Axial image 




Axial image 



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208 MRI: Joints 



Anterior cruciate ligament: 

• Length: ca. 38 mm 

• Width: ca. 11 mm 

a Angle formed by tangents to the tibial plateau and the ante- 
rior surface of the anterior cruciate ligament: 55° 
b Angle formed by Blumensaat's line (dashed) and the ante- 
rior surface of the anterior cruciate ligament: 1.6° 
c Angle of posterior cruciate ligament: ca. 123° (abnormal at 

ca. 106°) 
d Line of posterior cruciate ligament should intersect the dis- 
tal femur. 
Abnormal c and d are indirect signs of anterior cruciate liga- 
ment rupture. 

Posterior cruciate ligament: 

• Length: ca. 38 mm 

• Width: ca. 18 mm 




Sagittal image at the level of the anterior cruciate ligament 



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Knee Joint 209 




Sagittal image at the level of the patellar ligament 




Sagittal image at the level of the posterior cruciate ligament 



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210 MRI: Joints 




Coronal image 



^ ^3> ^ <2 




lateral medial 



Wiberg classification of patellar shapes (right knee). (From Moller, T.B.: Rontgennor- 
malbefunde. Thieme, Stuttgart 1996.) 



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Ankle and Subtalar Joints 211 



Ankle and Subtalar Joints 

The bones comprising the ankle joint show normal position and con- 
figuration, with normal development of the ankle mortise. 
The bone marrow signal, trabecular pattern, and epiphyseal lines are all 
normal. 

The joint space is of normal width. The cortex shows normal thickness 
and smooth contours, especially along the tibial and talar articular sur- 
faces. There are no subchondral signal changes and no osteophytes. 
The lateral and medial ligaments are normal in their course, width, and 
signal characteristics. 

The talocalcaneal and talonavicular joints appear normal. The interos- 
seous ligament between the talus and calcaneus is intact. The Achilles 
tendon is normal in its course, width, and signal characteristics, and the 
preachilles fat is clear. The tendons and plantar aponeurosis are unre- 
markable. 
The soft tissues show no abnormalities. 



Interpretation 

The ankle joint and subtalar joint appear normal. 



Checklist 

Skeleton • Medial and lateral malleoli (ankle mortise), 

talus, calcaneus, tarsal bones: 

— Configuration 

— Position (shape, centering— see below) 

— Normal bone marrow signal 

— Epiphyseal plate closure after age 18 

— Normal trabecular pattern 
Articular surfaces • Congruence 

• Cortex: 

— Cortical thickness (uniform, no circumscribed 
expansion) 

• Contours: smooth and sharp, no subchondral 
signal changes (especially on the medial side = 
60% site of predilection for osteochondritis dis- 
secans), no discontinuities 

• Articular cartilage (if visible): 

— Thickness 

— Smooth surface 



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212 MRI: Joints 



Ligaments 



Subtalar joint 
(talocalcaneal 
joint, talonavi- 
cular joint) 
Soft tissues 



Lateral ligaments (in order of trauma frequency: 
anterior fibulotalar ligament, fibulocalcaneal 
ligament, posterior fibulotalar ligament): 

— Course (not wavy) 

— Signal intensity 

— Width 

— Smooth contours 

— Continuity 

— No periligamentous fluid 
Medial (deltoid) ligament: 

— Course 

— Signal intensity 

— Width (see below) 

— Smooth contours 

— Continuity 
Interosseous ligament: 

— Course 

— Continuity 
Achilles tendon: 

— Course 

— Width (see below) 

— Shape (transverse oval cross section) 

— Signal characteristics 

— Continuity (especially 2-6 cm above the cal- 
caneal attachment = site of predilection for 
tears) 

— Normal-appearing preachilles fat 
Configuration 

Position 

Width of joint space 

Tendons: 

— Flexor hallucis longus tendon is particularly 
important (especially in the tarsal tunnel be- 
hind the medial malleolus, which is a site of 
predilection for tendinitis and rupture) 

— Tibialis posterior (its navicular attachment is 
a site of predilection for rupture) 

— Course 

— Signal intensity (uniformly hypointense, no 
central signal change) 

— Width 

— No discontinuities 



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Ankle and Subtalar Joints 213 



— Wall of tendon sheath (no fluid increase or 
wall thickening) 

Plantar aponeurosis and calcaneonavicular liga- 
ment: 

— Shape 

— Width (see below) 

— Hypointense in all MRI sequences 

— No circumscribed expansion or nodularity 

— No subcutaneous edema 
Normal tarsal canal 

Soft tissues 
Blood vessels 




Fig. 1: Semicoronal image showing 
all of the posterior articular surface 
of the subtalar joint and portions of 
the medial and lateral malleoli 



Fig. 2: Semicoronal image showing 
the posterior articular surface, all of 
the tarsal canal, and the susten- 
taculum 



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214 MRI: Joints 



Important Data 
Position 

Semicoronal image plane: 

1 Calcaneal valgus angle = relation of the talar axis (line con- 
necting the bisectors of the corners of the ankle and subtalar 
joint surfaces) to the axis of the calcaneus (line connecting the 
bisectors of the corners of the subtalar joint and a line parallel 
to it through the narrowest part of the calcaneus): 

• Approximately 0° ± 10° 

2 Sustentacular angle (formed by a line connecting the corners 
of the lateral posterior joint surface and sustentaculum and a 
line perpendicular to a tangent to the sustentaculum and me- 
dial calcaneal tuberosity): 

• 18-28° 

Axial image plane (image is acquired 4 cm above the level where 
the lateral part of the talus is first visualized): 

3 Plantar talocalcaneal angle (formed by a line connecting the 
lateral corner of the posterior articular surface of the talus and 
the medial corner of its medial articular surface with a line 
bisecting the calcaneal articular surface and the midpoint of a 
parallel line through the caudal third of the calcaneus): 

• 60-70° 

4 Calcaneocuboid angle (angle between the longitudinal axes of 
the cuboid and calcaneus): 

• Approximately 20-35° 

5 Arch angle (angle between tangents to the inferior calcaneal 
border and the soft-tissue sole): 

• 20-30° 

6 Achilles tendon: 

• Anteroposterior diameter < 6 mm 

7 Lateral ligaments: 

• Width of the anterior talofibular ligament and calcaneofibu- 
lar ligament: 2-3 mm 

• Angle between the longitudinal axes of the first and second 
metatarsals = 7.4 ° ± 2.6° (> 9° is suspicious for hallux valgus) 

• Relation of calcaneus to talus: 1.8-2.1 

8 Boehler's angle (formed by a line connecting the posterosupe- 
rior and anterosuperior prominences of the calcaneus and a 
line through the sustentaculum tali): 

• 20-40° (signifies calcaneal integrity) 



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Ankle and Subtalar Joints 215 




Fig. 3: Axial image 4 mm above the 
plane in which the lateral part of the 
tarsus is first visualized 



VflHL, "TaJ jfl 








11 f I! 

H r 1 H 




|- ™ 'HjWU 




m>* \ ^Bdi^ vH 









Fig. 4: Axial image 8-10 mm above 
the plane in which the articular sur- 
face of the calcaneocuboid joint is 
first visualized 




Location of the semicoronal and axial image planes 



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216 MRI: Joints 




Sagittal image 




Coronal image 



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217 

MRI: Special Investigations 

Cranial Vessels 

The internal carotid arteries show normal course and caliber and are 
symmetrically disposed. Each carotid siphon is normal, showing no dis- 
placement or extrinsic compression. Intraluminal signal intensity is ho- 
mogeneous. 

The middle cerebral artery arises normally from the internal carotid on 
each side and forms normal insular loops. There is no circumscribed 
vascular narrowing or dilatation. The vessel lumen shows homo- 
geneous signal intensity. 

The anterior cerebral artery shows no signs of narrowing or displace- 
ment. 

The basilar artery shows a normal course and caliber and divides into 
normal-size posterior cerebral arteries. The anterior and posterior com- 
municating arteries on each side are normally developed and of normal 
size. No segments show convolution or circumscribed dilatation. 
The other evaluable portions of the neurocranium show no abnormali- 
ties. 

Interpretation 

The cranial vascular system appears normal. 

Checklist 

Internal carotid • Extracranial portion 

artery • Siphon 

• Intracranial portion 
Middle cerebral • Ml, M2, and M3 segments 
artery 

Anterior cerebral • Position (no displacement) 
artery • Course 

• Caliber (symmetry) 

• Signal characteristics (homogeneous intralumi- 
nal signal, no filling defect) 

• Contours (smooth, no circumscribed or beaded 
constrictions) 



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218 MRI: Special Investigations 



Basilar artery 



Posterior cerebral 
artery 



Anterior and 

posterior 

communicating 

arteries 

Venous vessels 

Neurocranium 

(imaged portions) 



No circumscribed outpouching (especially in the 
proximal and horizontal segments) 
Position 

Course (no excessive tortuosity, no impression 
on brain stem) 

Caliber (no general or circumscribed luminal di- 
latation) 

Signal characteristics (homogeneous intralumi- 
nal signal, no filling defect) 
Contours (smooth) 
Position 
Symmetry 
Course 

Caliber (symmetry) 
Signal characteristics 
No excessive tortuosity 

No circumscribed dilatation, especially in the 
proximal segment 
Presence 
Course 
Caliber 

Signal characteristics 
No arteriovenous communications 
No abnormalities 




MR angiogram of the cranial arteries, coronal view 



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Cranial Vessels 219 




MR angiogram of the cranial arteries, axial view 




MR angiogram of the cranial arteries, lateral view 



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220 MRI: Special Investigations 



Cranial Venous Vessels 

MRI of the venous cranial vessels demonstrates a superior sagittal sinus 
of normal caliber with normal arrangement of draining superficial cere- 
bral veins. The great cerebral vein and inferior sagittal sinus appear nor- 
mal. The transverse sinus presents a normal caliber and usually shows 
slight asymmetry between the right and left sides. The other evaluable 
deep cerebral veins are normally developed and patent. No venous seg- 
ments contain flow voids or filling defects. 

The other evaluable portions of the neurocranium show no abnormali- 
ties. 



Interpretation 

The cranial venous vascular system appears normal. 



Checklist 

Supratentorial 
venous system 



Infratentorial 
venous system 



Superior sagittal sinus, superficial cerebral veins 
(ascending cerebral veins), deep cerebral veins: 

— Internal cerebral vein 

— Great cerebral vein (of Galen) 

— Straight sinus 

— Superficial middle cerebral vein 

— Sphenoparietal sinus 

— Cavernous sinus 

— Inferior petrosal sinus 
Sinus confluence 

Transverse sinuses (bilaterally symmetrical only 
in 20% of cases; 25% of cases have unilateral 
drainage, and more than 50% of cases show pre- 
dominant right-sided drainage; bilateral asym- 
metry is normal, usually with a right-sided pre- 
dominance) 
Sigmoid sinus 
Jugular bulb 

Position (no displacement) 
Course (no excessive tortuosity, normal calibers, 
no general or circumscribed luminal dilatation) 
Signal characteristics (homogeneous intralumi- 
nal signal, no filling defect) 
Contours (smooth, no constrictions) 



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Cranial Venous Vessels 221 



• No circumscribed outpouching 

• No arteriovenous communications 
Neurocranium • No abnormalities 

(imaged portions) 




Phase-contrast angiogram of the cranial veins, anteroposterior view 



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222 MRI: Special Investigations 




Phase contrast angiogram of the cranial veins, lateral view 




Contrast-enhanced maximum intensity projection (MIP) emphasizing the cranial 
veins, lateral view 



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MR Angiography of the Renal Arteries 223 



MR Angiography of the Renal Arteries 

The abdominal aorta displays normal course and caliber. 
The renal arterial trunks are paired, arise at the proper level, and show 
normal distribution. The course, calibers, and contours of the renal ves- 
sels are normal, with no evidence of caliber irregularities. 
The kidneys are paired and are normal in their position, shape, size, and 
borders. 
Other imaged vessels show no abnormalities. 



Interpretation 

The renal arteries appear normal. 



Checklist 
Abdominal aorta • 



Renal arteries 



Renal paren- 
chyma 



Renal pelvis 



Ureters 



Position (almost straight course slightly to left of 
midline) 

Bifurcation (see below) 
Diameter (see below) 
No caliber irregularities 
No circumscribed or segmental narrowing 
Number (paired) 
Accessory polar arteries 
Origin from the aorta (see below) 
Further distribution (anterior and posterior main 
branches, segmental arteries) 
Diameter (see below) 

No caliber irregularities (circumscribed, seg- 
mental, beaded) 
No pathological vessels 
No stretching or splaying 
Paired renal organs 
Position (see below) 
Size (see below) 
Smooth organ contours 
Structure 

Bilateral symmetry 
Width 

Shape of calices 
Not duplicated (one per side) 
Course 



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224 MRI: Special Investigations 



• Diameter (see below) 

• No obstruction of urinary drainage 
Other imaged • Course 

vessels (e.g., iliac • Caliber (see below) 
vessels, spinal 
arteries, superior 
and inferior mes- 
enteric arteries) 
Venous phase • Course 
(if documented, • Caliber (see below) 
e.g., inferior vena 
cava and renal veins) 



Important Data 

1 Abdominal aorta: 

• Approximately 18-30 mm 

2 Aortic bifurcation: 

• At approximately the L4-L5 level 

3 Origin of renal arteries: 

• At approximately the L1-L2 level 

4 Renal artery: 

• Diameter approximately 4-10 mm 

5 Position of superior poles of kidneys: 
a Right: superior border of LI 

b Left: inferior border of T12 (right kidney is lower than left 
kidney by up to one vertebral body height) 

6 Distance between superior renal poles: 

• Approximately 10 cm (4-16 cm) 

7 Distance between inferior renal poles: 

• Approximately 13 cm (9-18.5 cm) 

8 Renal dimensions: 

• Craniocaudal: 8-13 cm (<1.5 cm craniocaudal difference in 
renal sizes) 

Renal cortical thickness: 

• 4-5 mm 

Time to corticomedullary equilibrium: 

• 1 minute 



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MR Angiography of the Renal Arteries 225 




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226 MRI: Special Investigations 



9 


Contrast excretion into the pyelocaliceal system: 




• 3 minutes 


10 


Width of ureter: 




• 4-7 mm 




Inferior vena cava: 




• Transverse diameter up to 2.5 cm 




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Pelvic and Lower Limb Vessels 227 



Pelvic and Lower Limb Vessels 

The abdominal aorta is normal in its course, diameter, and filling. 
The aortic bifurcation occurs at a normal level, with normal visualiza- 
tion of the common, internal, and external iliac arteries. 
Both common femoral arteries have normal calibers, smooth walls, and 
a homogeneous intraluminal signal. The femoral arteries show a normal 
course, caliber, and distribution. 

The superficial femoral artery appears normal, especially within the ad- 
ductor canal. Like the popliteal artery, the vessel shows a normal course 
and no irregularities in its caliber. It divides normally into the three 
lower leg arteries, which show normal course, caliber, and distribution. 



Interpretation 

The vascular system of the pelvic and lower limb arteries appears nor- 
mal. 



Checklist 

Vascular course 
and caliber 
(described from 
center to 
periphery) 



Abdominal aorta: 

— Position: slightly to left of midline 

— Almost straight course 

— Bifurcation (see below) 
Common iliac artery 
External iliac artery 
Internal iliac artery 
Common femoral artery 
Superficial femoral artery (see below) 
Circumflex femoral artery 
Profunda femoris artery 

Popliteal artery (see below) 
Anterior tibial artery 
Posterior tibial artery 
Peroneal (fibular) artery: 

— Position (no displacement) 

— Course (no excessive tortuosity or coiling) 

— Caliber 

— Signal characteristics (homogeneous intra- 
luminal signal, no filling defect) 



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228 MRI: Special Investigations 



Veins 

Vessels 

Soft tissues and 

bony structures 



— Contours (smooth; no circumscribed, seg- 
mental or beaded constrictions; particularly 
note superficial femoral artery in the adduc- 
tor canal) 

— No circumscribed outpouching (e.g., popliteal 
artery) 

No arteriovenous communications 
No pathologic vessels or cutoffs 
(If evaluable) 




Phase-contrast angiogram of the pelvic vessels 



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Pelvic and Lower Limb Vessels 229 



Important Data 

1 Bifurcation: 

• At approximately the L4-L5 level 
Vascular calibers: 

2 Abdominal aorta: 

• Approximately 2-4 cm 

3 Superficial femoral artery: 

• Approximately 0.7-1.5 cm 

4 Popliteal artery: 

• Approximately 0.6-1 cm 




Phase-contrast angiogram of the femoral vessels 



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230 MRI: Special Investigations 





Phase-contrast angiogram of the vessels about the 
knee joints 



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MR Cholangiopancreatography 231 



MR Cholangiopancreatography 

The common bile duct shows normal position, caliber, and length with a 
homogeneous, fluid-equivalent intraluminal signal. The cystic duct and 
imaged portions of the intrahepatic bile ducts also appear normal. The 
gallbladder is of normal size; it has smooth borders and homogeneous 
contents. 

The pancreatic duct shows normal position, length, and caliber with ho- 
mogeneous internal structure and smooth contours. 



Interpretation 

The bile ducts, gallbladder, and pancreatic duct appear normal. 



Checklist 

Common bile 
duct 



Gallbladder 



Course: 

— Usually slightly convex toward the left side 
Size: 

— Tapers slightly from its origin (the right and 
left hepatic ducts and common hepatic duct 
are of equal size) 

— No circumscribed caliber irregularities, espe- 
cially in the papillary area (e.g., prestenotic 
dilatation, discrete or segmental stenosis due 
to tumor or fibrosis) 

— No circumscribed narrowing (stricture) or di- 
latation 

Shape: 

— Contours (smooth, straight) 

— Number (one) 
Internal structure: 

— Homogeneous fluid-equivalent signal inten- 
sity 

— No calculi 

— No tumor 
Position 
Number (one) 
Shape 

Possible septation 
Size (see below) 



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232 MRI: Special Investigations 



Cystic duct and 
intrahepatic 
bile ducts 



Pancreatic duct • 



Contours: 

— Smooth 

— Straight 

— No diverticula 
Internal structure: 

— Homogeneous fluid-equivalent signal 

— No filling defect (sludge, stone, papilloma, 
carcinoma) 

Position (presence and number) 

Course 

Size 

Contours 

Filling 

Position: 

— Horizontal 

— Ascends toward left side 
Size: 

— Diameter tapers uniformly toward the 
duodenum 

— No circumscribed change in diameter (e.g., 
constriction by a tumor, cyst, or inflamma- 
tion; prestenotic dilatation due to a tumor; 
segmental ectasia such as the segmental ir- 
regularities in pancreatitis) 

Shape: 

— Contours (smooth with straight walls) 

— No irregular margins 

— Not sacciform 

— Not tortuous or dilated 
Internal structure: 

— Homogeneous fluid-equivalent signal 

— No calculi 

— No tumor 



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MR Cholangiopancreatography 233 



Important Data 

1 Gallbladder: 

• Horizontal diameter up to 5 cm (> 5 cm is suspicious for hy- 
drops) 

2 Width of common bile duct: 

• < 8 mm (after cholecystectomy: < 10 mm) 

3 Cystic duct: 

• Length ca. 4 cm 

4 Pancreatic duct: 

• Width: 1-3 mm 




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234 MRI: Special Investigations 



Cervical Arteries 

The aortic arch presents smooth walls and normal configuration. 
The brachiocephalic trunk arises normally and undergoes a normal di- 
vision into the subclavian artery, common carotid artery, and right 
vertebral artery. The left common carotid artery arises directly from the 
aortic arch, has a normal caliber, and shows no luminal narrowing or 
filling defects. The vertebral artery appears normal. 
The carotid bifurcation occurs at a normal level on each side and is nor- 
mally shaped. The external carotid artery and particularly the internal 
carotid artery are symmetrical on each side and have normal calibers. 
There is no circumscribed narrowing or expansion. 
The vessels display a homogeneous intraluminal signal. The carotid si- 
phon appears normal, showing no displacement or extrinsic compres- 
sion. 

The vertebral arteries are symmetrically disposed and take a normal 
course. They show normal luminal diameters with no filling defects or 
caliber irregularities as far as the basilar artery. 
The portions of the neck that are imaged and evaluable show no abnor- 
malities. 



Interpretation 

The supra-aortic system of arterial cervical vessels appears normal. 



Checklist 

Aortic arch • General form 

• Course 

• Caliber 

• Signal characteristics 

Origins: brachiocephalic trunk, left common 
carotid artery, left subclavian artery 

Brachiocephalic • Origin 

trunk • Division into right subclavian and right common 

carotid arteries 

Left and right • Position 

subclavian • Course 

arteries • Caliber 

• Signal characteristics 



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Cervical Arteries 235 



Common carotid 
artery 



Carotid 
bifurcation 



Internal carotid 
artery 



External carotid 
artery 

Vertebral artery 



Origin (usually the left artery arises directly from 
the aortic arch while the right artery arises with 
the subclavian artery from the brachiocephalic 
trunk) 
Symmetry 
Course 

Caliber (symmetry) 
Signal characteristics 
No excessive tortuosity 
No circumscribed dilatation 
Usually occurs at C4/5 or C3/4 level 
Shape 

No circumscribed narrowing, especially at the 
origin of the internal carotid artery 
Position (no displacement) 
Course 

Caliber (slight proximal dilatation due to the 
carotid sinus, right-left symmetry) 
Signal characteristics (homogeneous intralumi- 
nal signal, no filling defect) 
Contours (smooth, no circumscribed constric- 
tion or ulceration) 

No circumscribed narrowing (especially in the 
proximal segment) with poststenotic dilatation 
Symmetrical appearance of the carotid siphons 
Position 
Course 
Caliber 

Signal characteristics 

Origin (from the subclavian artery or, rarely, 
from the aortic arch) 
Position 

Course (no excessive tortuosity) 
Caliber (no general or circumscribed luminal di- 
latation) 

Caliber discrepancy (usually left > right) is com- 
mon 

Signal characteristics (homogeneous intralumi- 
nal signal, no filling defect) 
Contours (smooth) 



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236 MRI: Special Investigations 



Important Data 

Sites of predilection for stenosis: 

• Internal carotid artery: 

— Carotid bifurcation (ca. 2/3 of all carotid stenoses) 

— At entrance to the carotid siphon 

— Within the carotid siphon 

• Vertebral artery 

— Origin from the subclavian artery 

— Passage through dura at craniocervical junction 




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Index 



241 



200J|203| 

RI, 212, 21 



abdomen 
CT, 36-71 
MRI, 128-161 
acetabulum, MRI, 200 
Achilles tendon, MRI, 212, 214 
acromioclavicular joint, MRI, 187 

width, 188 
acromion, MRI, 187 
adrenal glands 
CT, [38, 46, 52, 57||6i|-^ 

dimensions, 39, 47 58, 62 
MRI, 130, 141, 145-149 
dimensions, 132, 138, 146-147 
ankle joint, MRI, 211-216 

dimensions, 214 
anterior cruciate ligament, MRI, 205 

dimensions, 208 
aorta 
abdominal aorta 
CT, diameter, || || || 
MRI, 22| 
dimensions, g5| [[H |l4| H| 

CT, diameter, 33, 62 
MRI, 169 
bifurcation, 224, 229 
diameter, 120 
aortic arch, MRI, 234 
arteries 
basilar, MRI, |T| 
carotid 
bifurcation, 235| 
common, MRI, 116, 235 
external, MRI, 235 
internal 
CT, 12 

MRI, 96, 217 235 
stenosis sites, 236 
cerebral, MRI 



anterior, 217-18 

middle, 217 

posterior, 218 
cervical, MRI, 234-236 
communicating arteries, MRI 

anterior, 218 

posterior, 218 
mesenteric 

CT, 51 

MRI, 224 
popliteal, MRI, 229 
pulmonary, diameter 

CT, 33 

MRI, 120 
renal arteries, MR angiography, |223| - |226| 

dimensions, 224-226 
spinal, MRI, 224 
subclavian, MRI, 234| 
superficial femoral, MRI, 229 
vertebral, MRI, 235 

stenosis sites, 236 

see also aorta; vessels 

atlantodental distance, 164 

auditory canal 

external, MRI, 101, 184 

internal 

CT,[TJ 
dimensions, 6, 15 

MRI, 100-103 
dimensions, 93, 102 
axilla, MRI, I|| 



B 

basal ganglia 
CT, 4 

MR1.H 
basilar artery, MRI, 218 
biceps tendon, MRI, 187 

diameter, 188 



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242 Index 



bicipital groove, MRI, 188 
bile ducts 

ct, [37I pi |si| 

width, 47, 53 
MRI, |l29t[l34| 
cholangiopancreatography, 231 
232 

intrahepatic, 232 
width, 131 136,233 
bladder, see urinary bladder 
Boehler's angle, MRI, |]4| 
bone marrow signal, MRI 
hip joint, 201 
knee joint, 204 
brachiocephalic trunk, MRI, 234 
brain stem 
CT,4 

MRI.H 
breast, MRI, 125-127 



calcaneal valgus angle, MRI, 2\4 
calcaneocuboid angle, MRI, |214| 
calvarium, CT, 5 
carotid artery, see arteries 
carpal tunnel, MRI, |l96| 
cavernous sinus 

cr,P 

MRI, 96 
cecum 
female 
CT, 64 
MRI, 150 
male 
CT, 68 
MRI, l|| 
cerebellopontine angle area 
CT, 14 
MRI, 101 
cerebellum 
CT,! 

MRI, 87 89, 101 
cerebral arteries, see arteries 
cerebral cortex 
CT, 4)j| 
MRI, 88 



cerebrum, MRI, 87 101 
cervical spaces 

CT,§7| 

MRI, 113 
cervical spine 

CT, 28, 72-75 
dimensions, 

MRI, 162-167 
dimensions, 164 
cervix 

CT, 65 

MRI, 151 162-167 
dimensions, 152 
Chamberlain's line, |ll4 |J64| 
chest 

CT,|iUl_ 

MRI,TUiHT27| 

cholangiopancreatography, 231-233 
clavicle 

CT,|3 

MRI, llj| HH 
cochlea 

CT, 13-14 

MRI, 89, 101 
colon haustrations 

CT, 38, 52 

MRI, 130, 141 
conus medullaris, MRI, 173 
corpora cavernosa, MRI, 159 
corpus callosum 

CT, 4 

MRI, 88 
corpus spongiosum, MRI, 159 
cortical sulcation 

CT, 3 

MRI, 87-88 
costophrenic sinus 

CT, 37, 45 

MRI, |!30t |J35l 
cranial nerves, MRI 

VII (facial), [uj^ 

VIII (vestibulocochlear), 100 
craniovertebral angle, 164 
CSF spaces 

CT, 12, 15 
MRI, 96, 101, 102 
cubital tunnel, MRI, 191 



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Index 243 


cystic duct, MRI, ||| 


cT.ra 






length, 233 


MRI, 150 
male 
CT, 68 






D 


MRI, 155 






deltoid muscle, MRI, |l87| 


retrobulbar, CT, 1" 






diaphragm 


femoral head, MRI, [ 


200 


.m 


CT, |32, 62 


femoral shaft, MRI, 


201 




MRI, 119 


frontal sinuses, see sinuses 


duodenum, CT, pl| 
dural sack, MRI, 169 








G 






dural tube, CT, 80-81 







elbow joint, MRI, 191 

dimensions, 192 
epididymis, MRI, 159 
esophagus 

CT, 27 

MRI, ll| 
wall thickness, 116 
ethmoid cells 

CT, 23 

MRI, 10| 
external auditory canal, MRI, 101 184 
external capsule 

CT, 4 

MRI, 88 
eye muscles, see muscles 



gallbladder 

dimens ions , gjj ft7| 
MRI, 129, 135 
cholangiopancreatography, 231-232 
dimensions, 131, 136, 233 
gerota fascia, thickness 
CT, 58, 62 
MRI, 14411471 
glenoid, MRI, 183-184, If 
glenoid angle, MRI, |188 
globe 
CT,0 
diameter, 19 
position, 6, 19 
MRI, 104 
diameter, 106 
position, 93, 107 
glottis, MRI, 116 



facet joints 
CT 
cervical spine, 73 
lumbar spine, 81 
thoracic spine, |77| 
MRI 
cervical spin e, |163| 
lumbar, 173 
thoracic spine, 169 
facial nerve, MRI, 100 
fat 
peripancreatic, CT, 51 
perirectal 
female 



head 

cT,|ja 

MRI, 87HiT7l 

heart 
CT,|| 

dimensions, 
MRI, 119, 126 
dimensions, 120 
hip joint, MRI, 200-203 

dimensions, 203 
humerus, MRI, 191 
humeral head, 186 



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244 Index 



iliac wings, MRI, 17| 
iliopsoal muscles, MRI, 15 



kidneys 
CT, 



i ys 

37-38, 52, 56-60, 62 



infraspinatus muscle, MRI, 187 
infundibulum 

CT, 12 

MRI, 
inguinal canal, MRI, |l59| 
interhemispheric fissure 

CT, 3 

MRI,|7| 
internal auditory canal 

CT, 13 
dimensions, 6, 15 

MRI, 100-103 
dimensions, 93, 102 
internal capsule 

CT, 4 

MRI.H 
intervertebral disk space 

CT 
cervical spine, j73| 
lumbar spine, po[^2| 



thoracic spine, |76j [78| 
MR] 

cervical spine, 163, 164 

lumbar spine, 172-173, 174 

thoracic spine, 168, 170 
ischiorectal fossa 
female 

CT, 64 

MRI, 150 
male 

CT, |6p 

MRl7|l55| 



J 

joints, MRI, 178-216 
Jones-Thomson ratio 
CT, 78, 82 



MRI, 174 



dimensions, 38, 47, 58 
MRI, 130, 135, 140-144,146 



dimensions, 132, T38H9t|l42t |m|- 

m 

renal arteries, angiography, 223-226 
knee joint, MRI, 204-210 
kyphotic angle, MRI, 170 



lacrimal gland 

CT, 18, 19 

MRI, 105, 107 
larynx 

CT, 27 

MRI.Tml 
left atrium, dimensions 

CT,||_ 

MRI, 120 
ligamenta flava 

CT, 82 

MRI,"|l74l 
ligaments, MRI 

ankle joint, 212, 214 

elbow joint, 192 

knee joint, 205, 206 
dimensions, 208 

wrist joint, 196 
liver 

CT,||-||g4l9.51- 
dimensions, 39, 46 

MRI, 129, 134-139,146 
dimensions, 131, 136 
intrahepatic bile ducts, 232 
lordosis, MRI, |T7^ 
lumbar spine 

CT, 80-83 
dimensions, 82 

MRI, 172-177,179-180 
dimensions, 174 
lumbosacral angle 

CT, 82 

MRI, 174, 180 



Moeller, Normal Findings in CT and MRI © 2000 Thieme 

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Index 245 



lungs 
CT. PPI 
MRI, |118J |i2l[?30| 

lymph nodes 
abdominal 

CT, 38, 51 52, 62 

MRI, 14§ 
cervical, MRI, 114 
female pelvis 

cr, m 

MRU15T1 

male pelvis 
CT, 65 

mriTqH 

M 

mandibular condyle, MRI, 183 
mastoid 
CT, 14 

MRI, 89, 101 184 
maxillary sinuses, see sinuses 
mediastinum 
CT, 32, 33 

MRI,|118|-|119T, |J20| 
muscles 
elbow joint, MRI, [l9| 
eye muscles 
CT, 17 

dimensions, 19 
MRI, 10| 
dimensions, 107 
female pelvis, CT, 65 
hip joint, MRI, 
male pelvis, 
neck 
CT, 28 

MRiT|nl 

oral floor 

CT, 27 

MRI, 
shoulder joint, MRI, fJ87 
myocardium, thickness 
CT, 34 
MRI, |122| 



ARl, 201 

s, CT, 69 



, 113 




N 

nasal cavity 
CT, 23 
MRI, 89, 
neck 
CT, 

MRI,|iJ2Hll7 
neck muscles 
CT, 28 
MRI, |114| 
nerve roots 
CT 
cervical spine, 73 
lumbar spine, 81 
thoracic spine, [77| 
MRI 
cervical spine, 163 
lumbar spine, 173 
thoracic spine, 169 

nerves 

facial (cranial nerve VII), MRI, IOC 
hip joint, MRI, 201 
median, MRI, 196 
optic 
CT,0 

dimensions, J6J |?9| 
MRI, 10| 
dimensions, 92, 107 
ulnar, MRI, 196 
vestibulocochlear (cranial nerve 

viii), mri, |Toq 

neurocranium 
CT, g-g pi Pi pj 
vessels.MW 

mri, 87-93, eajioil |o| pj 

vessels, 218, 221 
neuroforamina 
CT 

cervical spine, 73 

lumbar spine, 81 

thoracic spine, |77| 
MRI 

cervical spine, 163 

thoracic spine, 169 



Moeller, Normal Findings in CT and MRI © 2000 Thieme 

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246 Index 



dimensions, 



optic chasm 

CT,|I| 
dimensions, 10 

MRI, 96 
dimensions, 98 
optic nerve, see nerves 
oral floor muscles 

CT. E7I 

MRI, [113| 
orbit 

ctMMM 

walls, 17 

mri, 90, lioj - |io7| ,|ios 

ovaries 
CT, 65 

dimensions, 67 
MRI, lji| 

dimensions, 154 



pancreas 

ct, m EH i^-ip, m 

dimensions, 39, 53 

MRI, 129-13^ jl35j , |146| 
dimensions, 132 
pancreatic duct, MRI 

cholangiopancreatography, 232 

width, 233 
paranasal sinus 

CT,gJ|J|-E5 

MRI, 89, 105, |K)8| - |11U |1 
parapharyngeal structures 

CT,|3_ 

MRI, 109 
parotid gland 

MRI, ll| 
patella, MRI, 205, 206 
pelvis, female 
CT, 64-67 
dimensions, 67 
muscles, 65 
skeleton, 65 
vessels, 65 
MRI, 150-154 



nmm 



skeleton, 151 

soft tissues, 151 

vessels, 151 
pelvis, male 
CT, 68-71 

dimensions, 70 

muscles, 69 

skeleton, 69 

vessels, 69 
MRI. |l55Ml5q 

dimensions, 156-158 

skeleton, 156 

soft tissues, 156 

vessels, 156 
pericardium, thickness 
CT, 34 

mri, i|| 

petrous pyramids 

ct, iJMi, 

MRI, 89, 100 
pharynx 

CT, 23, 27 

MRI, 109, 113 
pituitary 

CT, 4, 10-11. 12 
dimensions, 6, 10 

MRI, 89, 95-9 
dimensions, 9§ ||-|| 
plantar talocalcaneal angle, MRI, 214 
popliteal artery, MRI, 229 
porta hepatis 

ct. WJ\Wl J52I 

MRI, |!29t P35| 
posterior cruciate ligament, MRI, 

m 

dimensions, 208| 
preodontoid space, [74] 
prostate 
CT, 69 

dimensions, 70 
MRI, 15| 
dimensions, 156 
pulmonary artery, see arteries 



Moeller, Normal Findings in CT and MRI © 2000 Thieme 

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Index 247 



radiocarpal angle, MRI, 198 
radius, MRI, 191 
rectum 
female 
CT, 64 

wall thickness, 67 
MRI, 15^ 
wall thickness, |154| 
male 
CT, 68 

wa ll th ickness, |70| 
MRI, 155| 
wall thickness, |158| 
renal arteries, see arteries 
retroperitoneal space 
CT, p7| 
MRI, 141 
retropharyngeal space, MRI, 164 
retrotracheal space, 164 
ribs 
CT,|2| 
MRI, rj| 
right atrium, dimensions 
CT, 33 
MRI, 12^ 
rotator cuff, MRI, 187 



sacroiliac joints, MRI, 178 
sacrum, MRI, |T79| 
scapula 

CT.P 

MRI, IIS 
scrotum, MRI, |l5g| 
sella 

CT, 4, 12 

MRI, 89, 95 
semicircular canals 

CT, 13-14 

MRI, 89, 101 
seminal vesicles 

CT, 69 
dimensions, ^ 

MRI, 155-156 
dimensions, 158 



shoulder joint, MRI, 186-19C 

muscles, 187 
sinuses 
cavernous 
CT, 12 
MRI, 96 
costophrenic 
CT, 37, 45 
MRI, 130, 135 
frontal 
CT,|| 

height, H 
MRI, 10| 
height, |iiol 
maxillary 
CT, 23 

dimensions, 25 
MRI, 108-109 
dimensions, 110 
paranasal 
CT, 5, 18, 22-25 
MRI, 89, 105, 108-1 
sphenoid 
CT,|i2i p3l 

width, 25 
MRI, 96, 108 
width,1iTo| 
skeleton 
ankle joint, MRI, 
female pelvis 
CT, |65| 
MRI, 151 
male pelvis 
CT,||_ 
MRI, 156 
thoracic 
CT. P 
MRI, 119 
small bowel 
CT, 38, 52, 62 
MRI, 130, 141, 146 
soft tissues 
abdominal 
CT,|38, 57 
MRI, Sif 
ankle joint, MRI, |||-|IT| 
breast, MRI, |l2| 



211 



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248 Index 



soft tissues, cervical 
CT,||-|5|| 

dimensions, 29 
MRI, 112-117 163 
dimensions, 114 
elbow joint, MRI, 192 
female pelvis 
CT, 65 
MRl.pll 
knee joint, MRI, |205 
lumbar 
CT, 
MRI, 
male pelvis 

MRI, l|| 
sacroiliac joints, MRI, 180 
temporomandibular joint, MRI, 185 
thoracic 
CT, 32, 77 
MRI, 119, 169 
wrist joint, MRI, 196 
sphenoid sinus, see sinuses 
spinal column 
CT, 72-83 
cervical spine, ' 

dimensions, 74- 
lumbar spine, 80-83 

dimensions, 82 
thoracic spine,£9-[7^ 
dimensions, 78 
MRI, 162-182 
cervical spine, 114, 162-167 

dimensions, 164 
lumbar spine, |r72P|T77| , |l79| - po| 

dimensions, 174 
sacroiliac joints, 

dimensions, 180 
thoracic spine, 
dimensions, 
spinal cord 
CT 
cervical spine, ' 

width, ' 
thoracic spine, ' 
MRI 
cervical spine, 163 




width, 164 
thoracic spine, |168| - |169| 
spleen 
CT, 37, 46, 52, 61 

dimensions, 39, 47, 62 
MRI, 129, 135, 146 
dimensions, 131 138, 147 
sternum 
CT, 32 
MRI, 119 
stomach 
CT, 51,62 
MRI, 14§ 
subclavian artery, MRI, 234 
submandibular gland 
CT,|3_ 
MRI, lT| 
subscapularis muscle, MRI, 187 
subtalar joint, MRI, |l| 
suprasellar CSF spaces 
CT, 12, 15 
MRI, 96 
supraspinatus muscle, MRI, 187 
sustentacular angle, MRI, 214 
symphysis pubis, width 
female 
CT,|7J_ 
MRlT|l54l 
male 
MRI, 156 



talocalcaneal joint, MRI, 212 
talonavicular joint, MRI, 212 
temporomandibular joint, MRI, 183-1 
teres minor muscle, MRI, 187 
testes, MRI, |l59l-|l6l] 

dimensions, 160 
thalamus 

CT, 4 

MRI, 88 
thoracic spine 

CT, 72-79 
dimensions, ^8J 

MRI, 168-171 
dimensions, 170 



Moeller, Normal Findings in CT and MRI © 2000 Thieme 

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Index 249 


thorax 


supratentorial venous system, 


CT.PjrM 


|2g 


MRI,|118|-|127| 


hepatic 


thyroid gland 


CT, dimensions, 46 


CT, 27-28 


MRI, dimensions, |l38j 


dimensions, 29 


mesenteric, CT, 51 


MRI, ll| 


ophthalmic 


dimensions, 116 


CT, 18 


trachea, MRI, [jl| 


dimensions, J6J |J9| 


tunica albuginea, MRI, 159 


MRI, 10| 


tympanic cavity, MRI, 101 


dimensions, 92, 107 




portal 




CT, dimensions, 46 


U 


MRI, dimensions, |l38j 


ulna, MRI, l||] 


renal, MRI, E22| 


ulnar nerve, MRI, 196 


splenic, CT, 51 


ureters 


see also vena cava; vessels 


CT,|38lE56| 


vena cava 


width, 58 


inferior 


MRI, 130, 140, 223-224 
width, 142, 226 


CT.H 


diameter, 39, 58 


urinary bladder 


MRI, 22| 


female 


diameter, [J3^ |l3§ [J4| 


CT, 65 


superior 


wall thickness, ^ 


CT, diameter, |33| 


MRI, 151 


MRI, diameter7|l20| 


wall thickness, |154| 


ventricles 


male 


CT, 4 


CT, 69 


dimensions, 6 


wall thickness, ^ 


MRI, 88 


MRI, l|| 


dimensions, ^ 


wall thickness, |158| 


ventricular septum, thickness 


uterus 


CT, 34 


CT, 65 


MRI, 120 


dimensions, 66 


vertebral bodies 


MRI, 150-151 


CT 


dimensions, [152] 


cervical spine, f72|— 173| 




lumbar spine, 80 




thoracic spine, [76| 


V 


MRI 


vagina 


cervical spine, 162 
lumbar spine, 172, 173 


CT,|3 
MRI,|151| 
veins 


thoracic spine, 168 


vessels 


cranial, MRI 


abdominal 


infratentorial venous system, 


CT, 38, [57 




n^-im 


MRI, 141 


146 



Moeller, Normal Findings in CT and MRI © 2000 Thieme 

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250 Index 



vessels, cervical, MRI, 114| sacroiliac joints, MRI, 180 

cranial thoracic 

CT, 4 CT, [32) 

MRI, 89, 217-222 MRI,"[lTg| 

neurocranium, 218, 221 see also arteries; veins 

venous vessels, 220-222 vestibulocochlear nerve, MRI, |lOC 
hip joint, MRI, 201 
iliac, MRI, 224| 

lower limb, MRI, ^27| - po| w 

pelvis, HJiH white matter 

female CT, 0, B 

CT, 65 MRI, § 

MRI. Ml wrist joint, M RI, |l95i - |T9g| 

male dimensions, 198 
CT, 69 
MRI, 156 



Moeller, Normal Findings in CT and MRI © 2000 Thieme 

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